Provider Demographics
NPI:1619937380
Name:CALLER, KATHRYN (PAC)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:CALLER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:HUDGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:15101 E ILIFF AVE
Mailing Address - Street 2:STE 140
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014
Mailing Address - Country:US
Mailing Address - Phone:303-996-9601
Mailing Address - Fax:303-369-2605
Practice Address - Street 1:15101 E ILIFF AVE
Practice Address - Street 2:STE 140
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014
Practice Address - Country:US
Practice Address - Phone:303-996-9601
Practice Address - Fax:303-369-2605
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1255363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1035184OtherNATIONAL COMMISSION ON CE
CO57105537Medicaid