Provider Demographics
NPI:1639734239
Name:COOKSON, KATELYN A (PA)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:A
Last Name:COOKSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:A
Other - Last Name:COWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10465 PARK MEADOWS DR STE 201
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5321
Mailing Address - Country:US
Mailing Address - Phone:303-790-1515
Mailing Address - Fax:303-790-1989
Practice Address - Street 1:1635 AURORA CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2541
Practice Address - Country:US
Practice Address - Phone:720-848-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0005842363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical