Healthcare Provider Details

I. General information

NPI: 1003738683
Provider Name (Legal Business Name): KINETIC MIND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 E 16TH AVE
DENVER CO
80218-1628
US

IV. Provider business mailing address

12401 CLERMONT ST
THORNTON CO
80241-3039
US

V. Phone/Fax

Practice location:
  • Phone: 720-443-3490
  • Fax:
Mailing address:
  • Phone: 720-202-9136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN BOUCHARD
Title or Position: NURSE PRACTITIONER
Credential: ANP
Phone: 720-443-3490