Provider Demographics
NPI:1255596870
Name:HUMPHREY, KATHERINE ANN (NP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANN
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14026 PARK COVE DR
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-6596
Mailing Address - Country:US
Mailing Address - Phone:303-465-5774
Mailing Address - Fax:
Practice Address - Street 1:255 UNION BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1810
Practice Address - Country:US
Practice Address - Phone:303-763-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO79415363LF0000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily