Provider Demographics
NPI:1780977868
Name:JOHNSON, KATE (DPM)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S. SHEILDS STREET
Mailing Address - Street 2:BUILDING F
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1833
Mailing Address - Country:US
Mailing Address - Phone:970-493-4660
Mailing Address - Fax:970-493-6710
Practice Address - Street 1:3880 GRANT AVE STE 140
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8433
Practice Address - Country:US
Practice Address - Phone:970-667-0769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY151213E00000X
CO0000740213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist