Provider Demographics
NPI:1609095207
Name:TIEDT, KATHERINE (NP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:TIEDT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:WINDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:7750 S BROADWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2623
Mailing Address - Country:US
Mailing Address - Phone:303-730-6000
Mailing Address - Fax:303-730-8964
Practice Address - Street 1:7750 S BROADWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2623
Practice Address - Country:US
Practice Address - Phone:303-730-6000
Practice Address - Fax:303-730-8964
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO124358363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO74855034Medicaid
CO74855034Medicaid
COP00877585Medicare PIN