Provider Demographics
NPI:1932894995
Name:HARTLEY, KATHRYN ANN (APRN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANN
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 ALBION ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-4918
Mailing Address - Country:US
Mailing Address - Phone:210-268-2630
Mailing Address - Fax:
Practice Address - Street 1:400 S MCCASLIN BLVD STE 210
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:CO
Practice Address - Zip Code:80027-9701
Practice Address - Country:US
Practice Address - Phone:303-993-7910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-06
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1665636163W00000X
TX936551163W00000X
TX1114503363LF0000X
CO0998399363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse