Healthcare Provider Details

I. General information

NPI: 1023493939
Provider Name (Legal Business Name): KATHERINE KELTO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE BRANDON NP

II. Dates (important events)

Enumeration Date: 07/22/2015
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6915 TUTT BLVD SUITE 110B
COLORADO SPRINGS CO
80923-3591
US

IV. Provider business mailing address

1065 NE 125TH STREET SUITE 409
NORTH MIAMI FL
33161-5834
US

V. Phone/Fax

Practice location:
  • Phone: 719-445-1292
  • Fax: 719-591-6486
Mailing address:
  • Phone: 888-852-6672
  • Fax: 305-503-7363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN.1617420
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0992076-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: