Provider Demographics
NPI:1891474151
Name:STALEY, KATRINA RAENAE (FNP-C)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:RAENAE
Last Name:STALEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:RAENAE
Other - Last Name:KARAKAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1576 CLARENDON DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-2681
Mailing Address - Country:US
Mailing Address - Phone:801-388-6335
Mailing Address - Fax:
Practice Address - Street 1:2928 W 10TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-5426
Practice Address - Country:US
Practice Address - Phone:970-584-2100
Practice Address - Fax:970-584-2101
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0998883-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily