Healthcare Provider Details

I. General information

NPI: 1346110293
Provider Name (Legal Business Name): KATHERINE HAMILTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2025
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COLORADO AVE
PUEBLO CO
81004-2006
US

IV. Provider business mailing address

300 COLORADO AVE
PUEBLO CO
81004-2006
US

V. Phone/Fax

Practice location:
  • Phone: 719-543-8711
  • Fax: 719-543-8711
Mailing address:
  • Phone: 719-543-8711
  • Fax: 719-543-8711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1002342-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number0196420
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: