Provider Demographics
NPI:1407108939
Name:BLACKER, KATRINA LYNN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:LYNN
Last Name:BLACKER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6980 WILDRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-2820
Mailing Address - Country:US
Mailing Address - Phone:913-449-4841
Mailing Address - Fax:801-492-1991
Practice Address - Street 1:4701 SANGAMORE RD STE N100
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20816-2558
Practice Address - Country:US
Practice Address - Phone:914-919-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0995818-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily