Provider Demographics
NPI:1003415407
Name:JOHNSON, KATHERYN (CPT, CRNA, PTC)
Entity type:Individual
Prefix:
First Name:KATHERYN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CPT, CRNA, PTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11953 W HORNSILVER MTN
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-3231
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3914 SANDALWOOD LN
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-2586
Practice Address - Country:US
Practice Address - Phone:719-204-5008
Practice Address - Fax:719-982-7494
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2021-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0011-5573246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy