1639734239 NPI number — KATELYN A COOKSON PA

Table of content: KATELYN A COOKSON PA (NPI 1639734239)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639734239 NPI number — KATELYN A COOKSON PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOKSON
Provider First Name:
KATELYN
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COWAN
Provider Other First Name:
KATELYN
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639734239
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10465 PARK MEADOWS DR STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONE TREE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80124-5321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-790-1515
Provider Business Mailing Address Fax Number:
303-790-1989

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1635 AURORA CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80045-2541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-848-0000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA.0005842 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)