Provider Demographics
NPI:1881626216
Name:JOHNSON, KATHERINE KIRKLAND (NP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:KIRKLAND
Last Name:JOHNSON
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 1:9475 S UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-7802
Mailing Address - Country:US
Mailing Address - Phone:303-265-3364
Mailing Address - Fax:
Practice Address - Street 1:9475 S UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-7802
Practice Address - Country:US
Practice Address - Phone:303-265-3364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0114616163W00000X
COAPN.0002275-NP363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO55138870Medicaid
CO55138870Medicaid
COCO307671Medicare PIN
P75310Medicare UPIN
COP01330339Medicare PIN