Healthcare Provider Details

I. General information

NPI: 1386225522
Provider Name (Legal Business Name): KATELYN MIRANDA DEVERAUX DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 PATTERSON RD # RS
GRAND JUNCTION CO
81505-1438
US

IV. Provider business mailing address

2570 PATTERSON RD # RS
GRAND JUNCTION CO
81505-1438
US

V. Phone/Fax

Practice location:
  • Phone: 970-298-6601
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDR.0069707
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: