NPIMap

Individual provider Active NPI

Colleen Anne Kilcullen, NP

  • Adult Health Nurse Practitioner
  • Longmont, CO
National Provider Identifier
1790179448
Registry record updated Sep 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
APN.0091467-NP Issued in CO
Practice address
2101 Ken Pratt Blvd Ste 104a
Longmont, CO 80501-6568
Phone
(303) 415-4155
Fax
(303) 776-3109
NPI assigned
Mar 20, 2015
Last updated
Sep 30, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X APN.0091467-NP CO Primary
Gerontology Nurse Practitioner 363LG0600X APN.0091467 CO

Addresses

Primary practice location

2101 Ken Pratt Blvd Ste 104a
Longmont, CO 80501-6568

Mailing address

PO Box 9049
Boulder, CO 80301-9049
Phone (303) 415-4155

Other practice location 1

2030 Mountain View Ave
Ste 300
Longmont, CO 80501-3178
Phone (720) 652-8400

Other practice location 2

2101 Ken Pratt Blvd Ste 200
Longmont, CO 80501
Phone (303) 649-3500

Other identifiers 1

IdentifierTypeStateIssuer
97978353MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150923001914 CO Practitioner - Nurse Practitioner 0446567481 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Boulder Community HealthGroup PAC ID 6800707233, 260 clinicians
Legacy Healthcare Services IncGroup PAC ID 2163339722, 3,431 clinicians

Practice addresses (Care Compare)

2101 Ken Pratt Blvd
Suite 104a
Longmont, CO 80501-6568
Phone (303) 415-4155

22 S Adams St
Denver, CO 80209-2908
Phone (303) 321-2452

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APN.0091467-NPCOMDAdult Health Nurse Practitioner
APN.0091467COMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Boulder Community Health CurrentSince Jan 4, 2022 Accepting new patients
Boulder Community Health CurrentSince Jan 4, 2022 Accepting new patients
Boulder Community Health Current Accepting new patients
Boulder Community Health Past Accepting new patients
Boulder Community Health Past Accepting new patients

Locations

1755 48th St
Ste 200
Boulder, CO 80301
Phone (303) 415-7450

5450 Western Ave
Boulder, CO 80301
Phone (303) 415-4770

2101 Ken Pratt Blvd
Ste 104A
Longmont, CO 80501
Phone (303) 415-4155

2101 Ken Pratt Blvd
Ste 200
Longmont, CO 80501
Phone (303) 649-3500

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 38

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1426809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727654400000",
    "number": "1790179448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9049",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803019049",
            "telephone_number": "303-415-4155",
            "fax_number": "303-776-3109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 KEN PRATT BLVD STE 104A",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805016568",
            "telephone_number": "303-415-4155",
            "fax_number": "303-776-3109"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2030 Mountain View Ave",
            "address_2": "Ste 300",
            "address_purpose": "LOCATION",
            "city": "Longmont",
            "state": "CO",
            "postal_code": "805013178",
            "country_code": "US",
            "telephone_number": "720-652-8400",
            "fax_number": "720-652-8415",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2101 Ken Pratt Blvd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Longmont",
            "state": "CO",
            "postal_code": "80501",
            "country_code": "US",
            "telephone_number": "303-649-3500",
            "fax_number": "303-649-3501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KILCULLEN",
        "first_name": "COLLEEN",
        "middle_name": "ANNE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-20",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CO",
            "license": "APN.0091467-NP",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CO",
            "license": "APN.0091467",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "97978353",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Longmont, CO

Sources for this page

Verify at the official NPI Registry.