Basic Information
| Provider Information | |||||||||
| NPI: | 1164188306 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REEVES | ||||||||
| FirstName: | KATIE | ||||||||
| MiddleName: | DIREEN | ||||||||
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| Credential: | FNP-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WESTON | ||||||||
| OtherFirstName: | KATIE | ||||||||
| OtherMiddleName: | DIREEN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10900 W 44TH AVE | ||||||||
| Address2: | UNIT 200 | ||||||||
| City: | WHEAT RIDGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800332742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039931330 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 614 KOHLER FARMS RD | ||||||||
| Address2: | |||||||||
| City: | KERSEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806449623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702273255 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2021 | ||||||||
| LastUpdateDate: | 01/03/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APN.0997075-NP | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.