MEDICARE: KATELYN ANNE NELSON

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	163W00000X	Registered Nurse	646762	NY
2	163W00000X	Registered Nurse	RN.1669166	CO
3	363LP0200X	Pediatric Nurse Practitioner	F382368	NY
4	363LP0200X	Pediatric Nurse Practitioner	50864	WY
5	363LP0200X	Pediatric Nurse Practitioner	APN.0995670-NP	CO

General Provider Information

NPI Number	:	1891048450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN ANNE NELSON

Provider Business Mailing Address
First Line	:	6011 E WOODMEN RD STE 115
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-2603
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6011 E WOODMEN RD STE 115
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-2603
Country	:	US
Telephone Number	:	970-527-1122
Fax Number	:

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

Provider Enumeration Date	:	10/19/2012
Last Update Date	:	11/04/2022

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Directions to “ KATELYN ANNE NELSON ” Practice Location

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