Provider Demographics
NPI:1326873688
Name:COLOVOS, KATELYN JOY
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:JOY
Last Name:COLOVOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:
Other - Last Name:GELNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4841 SOUTHERN AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-3513
Mailing Address - Country:US
Mailing Address - Phone:717-602-2233
Mailing Address - Fax:
Practice Address - Street 1:4841 SOUTHERN AVE SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-3513
Practice Address - Country:US
Practice Address - Phone:717-602-2233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM57553163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse