Healthcare Provider Details

I. General information

NPI: 1184420457
Provider Name (Legal Business Name): KATHERINE COLLEEN KORENEK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1079 S HOVER ST STE 200
LONGMONT CO
80501-7924
US

IV. Provider business mailing address

1079 S HOVER ST STE 200
LONGMONT CO
80501-7924
US

V. Phone/Fax

Practice location:
  • Phone: 720-680-8351
  • Fax: 303-565-5290
Mailing address:
  • Phone: 720-680-8351
  • Fax: 303-565-5290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberC-RXN.0103883-C-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number937933
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberC-APN.0105855-C-NP
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1192374
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: