Healthcare Provider Details

I. General information

NPI: 1891048450
Provider Name (Legal Business Name): KATELYN ANNE NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2012
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6011 E WOODMEN RD STE 115
COLORADO SPRINGS CO
80923-2603
US

IV. Provider business mailing address

6011 E WOODMEN RD STE 115
COLORADO SPRINGS CO
80923-2603
US

V. Phone/Fax

Practice location:
  • Phone: 970-527-1122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number646762
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1669166
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF382368
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number50864
License Number StateWY
# 5
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPN.0995670-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: