Provider Demographics
NPI:1801206487
Name:PLUMMER, KATHY L (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:L
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7720 S. BROADWAY #440
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2624
Mailing Address - Country:US
Mailing Address - Phone:303-795-0890
Mailing Address - Fax:303-795-5933
Practice Address - Street 1:7720 S BROADWAY #440
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2624
Practice Address - Country:US
Practice Address - Phone:303-795-0890
Practice Address - Fax:303-795-5933
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO95439363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO37285343Medicaid
CO495628Medicare PIN