DR. KELLY JOY PETTIJOHN (NPI# 1023451176) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023451176 |
| Entity Type | Individual |
| Full Name | DR. KELLY JOY PETTIJOHN |
| Credential | M.D. |
| Practice Address |
2045 N Franklin St Denver CO 80205 |
| Mailing Address |
10350 E Dakota Ave Denver CO 80247-1314 |
| Practice Telephone | 3033384545 |
| Practice Fax Number | 3033447715 |
| Mailing Telephone | 3033384545 |
| Mailing Fax Number | 3033447715 |
| Enumeration Date | 2013-04-08 |
| Last Update Date | 2018-08-31 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207YX0007X |
Otolaryngology Specialization: Plastic Surgery within the Head & Neck |
DR.0060683 | CO | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | CO | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CO | KAISER COMMERCIAL NUMBER | 028886 | 01 |
| Street Address |
2045 N FRANKLIN ST |
| City | DENVER |
| State | CO |
| Zip Code | 80205 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659370773 | Mina S Lee | Urology | 2045 N Franklin St, Denver, CO 80205-5437 | 2005-07-20 |
| 1992306427 | Nicole L Maes | Technician/Technologist | 2045 N Franklin St, Denver, CO 80205-5437 | 2020-11-02 |
| 1881208395 | Matthew Westcomb | Registered Nurse | 2045 N Franklin St, Denver, CO 80205-5437 | 2020-09-02 |
| 1861030678 | Valerie Ann Davis | Registered Nurse | 2045 N Franklin St, Denver, CO 80205-5437 | 2019-12-12 |
| 1417506338 | Laurel Thorburn | Audiologist | 2045 N Franklin St, Denver, CO 80205-5437 | 2019-09-04 |
| 1164084893 | Deanna Dougherty | Registered Nurse | 2045 N Franklin St, Denver, CO 80205-5437 | 2019-07-02 |
| 1356905772 | Jason Saulo Hermosillo | Specialist/Technologist, Other | 2045 N Franklin St, Denver, CO 80205-5437 | 2019-05-01 |
| 1114485976 | Marissa E Heebner | Registered Nurse | 2045 N Franklin St, Denver, CO 80205-5437 | 2019-03-11 |
| 1194282913 | Nicole Hoffman | Registered Nurse | 2045 N Franklin St, Denver, CO 80205-5437 | 2019-02-28 |
| 1114484409 | Daniel Bernard Lockman | Specialist/Technologist, Other | 2045 N Franklin St, Denver, CO 80205-5437 | 2019-02-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235769233 | Abigail Eileen Taylor | Occupational Therapy Assistant | 3241 N York St, Denver, CO 80205 | 2020-01-19 |
| 1609415694 | Blushing Bodies | Clinic/Center | 2040 East 28th Ave, Denver, CO 80205 | 2019-12-23 |
| 1053966564 | Paul Deutsch | Social Worker | 3836 York St, Denver, CO 80205 | 2019-08-02 |
| 1770062085 | New Health Pain Treatment Centers, LLC | General Practice | 3605 S Teller, Englewood, CO 80205 | 2018-08-08 |
| 1710474374 | Paloma Dental | Dentist | 1225 35th Street, Denver, CO 80205 | 2018-04-19 |
| 1720516677 | Volunteers of America, Colorado Branch | Voluntary or Charitable | 2660 Larimer St., Denver, CO 80205 | 2017-05-23 |
| 1760917637 | Rino Dental | Dentist | 3258 Larimer St, Suite 300, Denver, CO 80205 | 2017-04-27 |
| 1891233193 | Barbara Jordan | Physical Therapist | 13123 East 16th Avenue, Box 295, Denver, CO 80205 | 2017-02-07 |
| 1255877635 | Kaiser Permanente | Clinic/Center | 1451 24th Street, Apt 146, Denver, CO 80205 | 2017-01-10 |
| 1255887501 | Stephanie W Kwong | Speech-Language Pathologist | 158 S Pacific Avenue, Denver, CO 80205 | 2016-08-28 |
| Find all providers in zip 80205 | ||||
| Taxonomy Code | 207YX0007X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| Specialization | Plastic Surgery within the Head & Neck |
| An otolaryngologist with additional training in plastic and reconstructive procedures within the head, face, neck and associated structures, including cutaneous head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery. The field is diverse and involves a wide age range of patients, from the newborn to the aged. While both cosmetic and reconstructive surgeries are practiced, there are many additional procedures which interface with them. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy is currently provided in the subspecialty of Otolaryngology/Facial Plastic Surgery (see Taxonomy Code 207YX0905X) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457502940 | Khalid Chowdhury Md, PC | Otolaryngology | 1601 E 19th Ave, Suite 3000, Denver, CO 80218-1216 | 2008-10-02 |
| 1407990120 | Phyllis Ann Bergeron | Otolaryngology | 1375 E 19th Ave, Denver, CO 80218-1114 | 2007-02-16 |
| 1295898187 | Ryan Andrew Gaines | Otolaryngology | 2555 S Downing St, Suite #100, Denver, CO 80210-5855 | 2006-12-19 |
| 1659473874 | Paul Harold Dragul | Otolaryngology | 850 E Harvard Ave, Ste #505, Denver, CO 80210-5073 | 2006-09-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902069545 | Michele Angelec Streeter | Otolaryngology | 1339 Phay Ave, Canon City, CO 81212-2301 | 2008-07-03 |
| 1174834972 | David Joseph Grindler | Otolaryngology | 10240 Park Meadows Dr, Lone Tree, CO 80124-5425 | 2010-06-25 |
| 1952445587 | Lawrence A Gordon | Otolaryngology | 10240 Park Meadows Dr, Lone Tree, CO 80124-5425 | 2007-02-16 |
| 1235218009 | Healthone Clinic Services LLC | Otolaryngology | 799 E Hampden Ave, Suite 530, Englewood, CO 80113-2786 | 2006-11-03 |
| 1053490839 | Andrew J Nemechek | Otolaryngology | 701 E Hampden Ave Ste 225, Englewood, CO 80113-2737 | 2006-11-03 |
| 1376560375 | Seth A Reiner, M.d., P.C. | Otolaryngology | 200 W County Line Rd, Suite 330, Highlands Ranch, CO 80129-2360 | 2006-07-16 |
| 1770522302 | Seth Allen Reiner | Otolaryngology | 200 W County Line Rd, Suite 330, Highlands Ranch, CO 80129-2360 | 2006-06-06 |
| 1508805045 | Henry Patrick Carr | Otolaryngology | 10099 Ridgegate Pkwy, Suite 230, Lone Tree, CO 80124-5531 | 2006-06-06 |
| 1285606764 | Frederic White-brown Deleyiannis | Otolaryngology | 13123 E 16th Ave, Aurora, CO 80045-7106 | 2006-02-07 |
Please comment or provide details below to improve the information on DR. KELLY JOY PETTIJOHN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.