MEDICARE: MS. KATHERINE DUCHEN SMITH RN MS CPNP

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	363LP0200X	Pediatric Nurse Practitioner	64219	CO

General Provider Information

NPI Number	:	1588651806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHERINE DUCHEN SMITH RN MS CPNP

Provider Business Mailing Address
First Line	:	1625 COUNTRY CLUB RD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-1982
Country	:	US
Telephone Number	:	970-221-0157
Fax Number	:	970-482-4560

Provider Business Practice Location Address
First Line	:	315 CANYON AVE
Second Line	:	SUITE A
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-2677
Country	:	US
Telephone Number	:	970-482-2136
Fax Number	:

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

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	07/08/2007

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