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General NPI Number Information
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NPI Number | 1003738683
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Entity Type | Organization
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Legal Business Name | KINETIC MIND LLC
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Dates
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Enumeration Date | 07/27/2026
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Last Update Date | 07/27/2026
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Provider Practice Location Address
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Address Line | 1731 E 16TH AVE
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City | DENVER
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State | CO
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Zip | 80218-1628
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Country | US
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Telephone | 720-443-3490
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Fax |
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Provider Business Mailing Address
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Address Line | 12401 CLERMONT ST
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City | THORNTON
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State | CO
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Zip | 80241-3039
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Country | US
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Telephone | 720-202-9136
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | KATHRYN BOUCHARD
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Credential | ANP
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Telephone | 720-443-3490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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