Healthcare Provider Details

I. General information

NPI: 1336070994
Provider Name (Legal Business Name): KATELYN KERSTETTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 S LEMAY AVE
FORT COLLINS CO
80524-3929
US

IV. Provider business mailing address

743 BENTHAVEN ST
FORT COLLINS CO
80526-3171
US

V. Phone/Fax

Practice location:
  • Phone: 970-685-1345
  • Fax:
Mailing address:
  • Phone: 970-685-1345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0191917
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: