Provider Demographics
NPI:1710771100
Name:ELAM, KERRI LEE
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:LEE
Last Name:ELAM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 COUNTY ROAD 1017
Mailing Address - Street 2:
Mailing Address - City:SILVERTHORNE
Mailing Address - State:CO
Mailing Address - Zip Code:80498-8920
Mailing Address - Country:US
Mailing Address - Phone:614-226-6193
Mailing Address - Fax:
Practice Address - Street 1:40 COUNTY ROAD 1017
Practice Address - Street 2:
Practice Address - City:SILVERTHORNE
Practice Address - State:CO
Practice Address - Zip Code:80498-8920
Practice Address - Country:US
Practice Address - Phone:614-226-6193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO190874163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse