Provider Demographics
NPI:1275892911
Name:PARKER, KATHLEEN SUSAN (RN, CNM)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:SUSAN
Last Name:PARKER
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:SUSAN
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CNM
Mailing Address - Street 1:1107 S LEMAY AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3960
Mailing Address - Country:US
Mailing Address - Phone:970-493-7442
Mailing Address - Fax:970-493-2990
Practice Address - Street 1:2500 ROCKY MOUNTAIN AVE
Practice Address - Street 2:NORTH MOB, SUITE 150
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9004
Practice Address - Country:US
Practice Address - Phone:970-493-7442
Practice Address - Fax:970-493-2990
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA808872163W00000X
NM813367A00000X
CA1987367A00000X
NV846113367A00000X
COAPN.0992524-CNM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000146136Medicaid
NM6652247Medicaid