MEDICARE: KATELYN GRAY RN,BSN,PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APN.0998228-NP	CO

General Provider Information

NPI Number	:	1588289904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN GRAY RN,BSN,PMHNP

Provider Business Mailing Address
First Line	:	1312 17TH ST UNIT 2376
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-1508
Country	:	US
Telephone Number	:	915-336-2125
Fax Number	:	720-680-3420

Provider Business Practice Location Address
First Line	:	1312 17TH ST UNIT 2376
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-1508
Country	:	US
Telephone Number	:	915-336-2125
Fax Number	:	720-680-3420

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2020
Last Update Date	:	10/30/2025

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