Kelly Wayne Tabor, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APN.0998433-NP Issued in CO

Practice address

9904 Cub Lake TRL
Colorado Springs, CO 80924-1202

Phone

(609) 680-1389

NPI assigned

Jan 30, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1675036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675900800000",
    "number": "1245946599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9904 CUB LAKE TRL",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809241202",
            "telephone_number": "609-680-1389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9904 CUB LAKE TRL",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809241202",
            "telephone_number": "609-680-1389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TABOR",
        "first_name": "KELLY",
        "middle_name": "WAYNE",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-01-30",
        "last_updated": "2023-02-09",
        "certification_date": "2023-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "APN.0998433-NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Family Nurse Practitioner in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.