Healthcare Provider Details

I. General information

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

Provider Other Name: KATHERINE KELTO PMHNP-BC

II. Dates (important events)

Enumeration Date: 07/22/2015
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5350 TOMAH DR
COLORADO SPRINGS CO
80918-6904
US

IV. Provider business mailing address

5350 TOMAH DR
COLORADO SPRINGS CO
80918-6904
US

V. Phone/Fax

Practice location:
  • Phone: 719-212-1448
  • Fax: 888-965-4615
Mailing address:
  • Phone: 719-212-1448
  • Fax: 888-965-4615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: