MEDICARE: KATHARINE BLAIR BROYLES F.N.P.-BC

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
1	363L00000X	Nurse Practitioner	APN.0997704-NP	CO

General Provider Information

NPI Number	:	1962837120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHARINE BLAIR BROYLES F.N.P.-BC

Provider Business Mailing Address
First Line	:	2769 IRIS AVE STE 108
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80304-4405
Country	:	US
Telephone Number	:	720-816-3228
Fax Number	:	775-363-1711

Provider Business Practice Location Address
First Line	:	2769 IRIS AVE STE 108
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80304-4405
Country	:	US
Telephone Number	:	720-816-3228
Fax Number	:	775-363-1711

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2013
Last Update Date	:	02/03/2026

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