Provider Demographics
NPI:1841262557
Name:WILLEMYNS, KATHLEEN J (NP)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:J
Last Name:WILLEMYNS
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 1:5920 MCINTYRE ST
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-7445
Mailing Address - Country:US
Mailing Address - Phone:720-434-4876
Mailing Address - Fax:303-225-4246
Practice Address - Street 1:5920 MCINTYRE ST
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80403
Practice Address - Country:US
Practice Address - Phone:303-434-4876
Practice Address - Fax:303-225-4246
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0004644-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO16435231Medicaid
COC303179Medicare PIN
COQ47734Medicare UPIN