Provider Demographics
NPI:1336796804
Name:ALEXANDER, KATHERINE ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANNE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-4123
Mailing Address - Fax:970-490-4173
Practice Address - Street 1:1400 E BOULDER ST STE 500
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5533
Practice Address - Country:US
Practice Address - Phone:719-364-4120
Practice Address - Fax:719-364-4121
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9112346363A00000X
COPA.0008585363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104039900Medicaid