Provider Demographics
NPI:1073099156
Name:HUBBARD, KATHRYN JOANN (APN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JOANN
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7954 NATIVE DANCER TRL
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-6470
Mailing Address - Country:US
Mailing Address - Phone:720-401-7220
Mailing Address - Fax:
Practice Address - Street 1:3455 RINGSBY CT STE 102
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-4923
Practice Address - Country:US
Practice Address - Phone:720-642-1125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0993939363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0993939OtherAPN