Healthcare Provider Details

I. General information

NPI: 1073268157
Provider Name (Legal Business Name): KATHERINE ELIZABETH LOECKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10081 WADSWORTH PKWY STE 200
WESTMINSTER CO
80021-3827
US

IV. Provider business mailing address

9060 WADSWORTH BLVD APT 218
WESTMINSTER CO
80021-4928
US

V. Phone/Fax

Practice location:
  • Phone: 303-431-5409
  • Fax:
Mailing address:
  • Phone: 913-961-1805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0007235
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: