Provider Demographics
NPI:1285898775
Name:CALLIS, KATHY LOUISE (RN)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:LOUISE
Last Name:CALLIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22153 E BELLEVIEW LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-6595
Mailing Address - Country:US
Mailing Address - Phone:541-999-5139
Mailing Address - Fax:
Practice Address - Street 1:22153 E BELLEVIEW LN
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-6595
Practice Address - Country:US
Practice Address - Phone:541-999-5139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO115240163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse