Healthcare Provider Details

I. General information

NPI: 1114862885
Provider Name (Legal Business Name): KATHRYN ELIZABETH BERTA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E BOULDER ST
COLORADO SPRINGS CO
80909-5533
US

IV. Provider business mailing address

1725 E BOULDER ST STE 101
COLORADO SPRINGS CO
80909-5740
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-5000
  • Fax:
Mailing address:
  • Phone: 719-365-6300
  • Fax: 719-365-6094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA009881
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: