Provider Demographics
NPI:1114556677
Name:WILLIE, KATHERINE AURORA (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:AURORA
Last Name:WILLIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11990 GRANT ST STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80233-1122
Mailing Address - Country:US
Mailing Address - Phone:303-537-8152
Mailing Address - Fax:
Practice Address - Street 1:11990 GRANT ST STE 101
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80233-1122
Practice Address - Country:US
Practice Address - Phone:303-537-8152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00726562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry