Healthcare Provider Details

I. General information

NPI: 1922794072
Provider Name (Legal Business Name): KATHERINE NELSON WILSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 N HIGH ST STE 340
DENVER CO
80205-5545
US

IV. Provider business mailing address

2055 N HIGH ST STE 340
DENVER CO
80205-5545
US

V. Phone/Fax

Practice location:
  • Phone: 303-832-2344
  • Fax: 303-832-3721
Mailing address:
  • Phone: 303-832-2344
  • Fax: 303-832-3721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: