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General NPI Number Information
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NPI Number | 1184587941
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Entity Type | Organization
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Legal Business Name | KWAKE PMH
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Dates
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Enumeration Date | 12/08/2025
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 115 WILCOX ST ST 200
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City | CASTLE ROCK
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State | CO
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Zip | 80104
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Country | US
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Telephone | 720-824-3324
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Fax |
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Provider Business Mailing Address
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Address Line | 115 WILCOX ST ST 200
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City | CASTLE ROCK
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State | CO
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Zip | 80104
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Country | US
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Telephone | 720-824-3324
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Fax |
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Authorized Official
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Title or Position | PMHNP
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Name | KATHLEEN SHEEREN WAKEFIELD
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Credential | APN, NP, RN
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Telephone | 720-935-0291
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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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