Healthcare Provider Details

I. General information

NPI: 1003099888
Provider Name (Legal Business Name): KATHERINE JEANNE CARLEY RN, MSN, CS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST
DENVER CO
80204-4507
US

IV. Provider business mailing address

777 BANNOCK ST
DENVER CO
80204-4507
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-6630
  • Fax: 303-430-6260
Mailing address:
  • Phone: 303-436-6630
  • Fax: 303-430-6260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number74262
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberAPN.0100013-CNS
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: