Provider Demographics
NPI:1912007451
Name:SHAVER, KATHRYN MARY
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARY
Last Name:SHAVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11750 W 2ND PL
Mailing Address - Street 2:SUITE 255
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1575
Mailing Address - Country:US
Mailing Address - Phone:720-321-8050
Mailing Address - Fax:720-321-8041
Practice Address - Street 1:11750 W 2ND PL
Practice Address - Street 2:SUITE 255
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1575
Practice Address - Country:US
Practice Address - Phone:720-321-8050
Practice Address - Fax:720-321-8041
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN47963163W00000X
COAPN.0002493-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC801234OtherMEDICARE
CO08577021Medicaid
COC801234OtherMEDICARE