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NPI Code Detail

MEDICARE: DR. KATELYN TAYLOR KIRK-PROVENCHER PHD

MEDICARE: DR. KATELYN TAYLOR KIRK-PROVENCHER PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TF0200XForensic PsychologistPSY.0006530CO
2103TC0700XClinical PsychologistPSY.0006530CO

General Provider Information

NPI Number : 1205653342
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KATELYN TAYLOR KIRK-PROVENCHER PHD
Provider Business Mailing Address
First Line : 3520 W OXFORD AVE
Second Line :
City : DENVER
State : CO
Zip : 80236-3108
Country : US
Telephone Number : 303-866-7066
Fax Number :
Provider Business Practice Location Address
First Line : 3520 W OXFORD AVE
Second Line :
City : DENVER
State : CO
Zip : 80236-3108
Country : US
Telephone Number : 38-667-0663
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2024
Last Update Date : 06/11/2026

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