Provider Demographics
NPI:1194392175
Name:KONKEN, KATIE LYNN
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:LYNN
Last Name:KONKEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BROADWAY ST STE 26
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-2734
Mailing Address - Country:US
Mailing Address - Phone:970-522-5294
Mailing Address - Fax:
Practice Address - Street 1:100 BROADWAY ST STE 26
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-2734
Practice Address - Country:US
Practice Address - Phone:970-522-5294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician