Provider Demographics
NPI:1053068734
Name:LIPSCOMB, KATY ROSE (PA-C)
Entity type:Individual
Prefix:
First Name:KATY
Middle Name:ROSE
Last Name:LIPSCOMB
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:ROSE
Other - Last Name:CARDOZO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-4123
Mailing Address - Fax:970-490-4173
Practice Address - Street 1:1625 MEDICAL CENTER PT STE 220
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-5798
Practice Address - Country:US
Practice Address - Phone:719-364-5080
Practice Address - Fax:719-364-5081
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15520363A00000X
COPA.0009113363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant