Active NPI
Sean Kelly
- Clinical Psychologist
- Colorado Springs, CO
National Provider Identifier
1013367069
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3110
- Practice address
- 4465 Northpark Dr Ste 309
Colorado Springs, CO 80907-4238 - Phone
- (719) 464-3163
- Fax
- (719) 452-3713
- NPI assigned
- Jun 20, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 3110 | CO | Primary |
Addresses
Primary practice location
4465 Northpark Dr Ste 309
Colorado Springs, CO 80907-4238
Mailing address
827 Valley Rd
Colorado Springs, CO 80904-1510
Phone (719) 464-3163
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3110 | CO | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1466380800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649635200000",
"number": "1013367069",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "827 VALLEY RD",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809041510",
"telephone_number": "719-464-3163"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4465 NORTHPARK DR STE 309",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809074238",
"telephone_number": "719-464-3163",
"fax_number": "719-452-3713"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "SEAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-06-20",
"last_updated": "2022-04-11",
"certification_date": "2022-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CO",
"license": "3110",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.