Provider Demographics
NPI:1306159256
Name:JOHNSON, KATHERINE ROBERTA (MSN, RN, CPNP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ROBERTA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSN, RN, CPNP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ROBERTA
Other - Last Name:METZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1225 LIVE OAK CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5569
Mailing Address - Country:US
Mailing Address - Phone:970-232-9301
Mailing Address - Fax:
Practice Address - Street 1:2001 SOUTH SHIELDS
Practice Address - Street 2:BUILDING G
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526
Practice Address - Country:US
Practice Address - Phone:970-484-4871
Practice Address - Fax:970-482-4927
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO178967363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics