Provider Demographics
NPI:1740467497
Name:COLE, KATIE A (PA)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:A
Last Name:COLE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:9224 TEDDY LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LONETREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-6798
Mailing Address - Country:US
Mailing Address - Phone:303-790-1515
Mailing Address - Fax:303-790-1989
Practice Address - Street 1:9224 TEDDY LN
Practice Address - Street 2:SUITE 220
Practice Address - City:LONETREE
Practice Address - State:CO
Practice Address - Zip Code:80124-6798
Practice Address - Country:US
Practice Address - Phone:303-790-1515
Practice Address - Fax:303-790-1989
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2012-11-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO2556363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04018362OtherGROUP MEDICAID
1699895755OtherGROUP NPI
WY109864100OtherGROUP MEDICAID
OK200293420 AOtherGROUP MEDICAID
CO56529767Medicaid
NE84127410413OtherGROUP MEDICAID