Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | APN.0992076-NP | CO |
NPI | 1023493939 |
---|---|
Provider Name | Katherine Kelto |
First Address | North Miami, FL 33161-5834 |
Second Address | Colorado Springs, CO 80923-3591 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2015 |
Last Update Date | 18/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
21770085 | (05) | CO |