Healthcare Provider Details

I. General information

NPI: 1407862386
Provider Name (Legal Business Name): KATHY ANN LOEFFLER NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 KANSAS AVE
WALSENBURG CO
81089-1818
US

IV. Provider business mailing address

23500 US HIGHWAY 160
WALSENBURG CO
81089-9524
US

V. Phone/Fax

Practice location:
  • Phone: 719-738-2718
  • Fax: 719-738-2732
Mailing address:
  • Phone: 719-738-5144
  • Fax: 719-738-5138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number125142
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: