Healthcare Provider Details

I. General information

NPI: 1831451152
Provider Name (Legal Business Name): KATHERINE L. CHURCHILL MSN, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHERINE LINDSAY VAN NOY MSN, APRN, PMHNP-BC

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5424 W HIGHWAY 290 STE 108
AUSTIN TX
78735-8827
US

IV. Provider business mailing address

825 E SPEER BLVD STE 8
DENVER CO
80218-3719
US

V. Phone/Fax

Practice location:
  • Phone: 512-430-1130
  • Fax: 512-677-6806
Mailing address:
  • Phone: 844-336-5597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number791448
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberC-APN.0002099-C-NP
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP121966
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: