Provider Demographics
NPI:1770982241
Name:COLEY, KATIA (NP-C)
Entity type:Individual
Prefix:MRS
First Name:KATIA
Middle Name:
Last Name:COLEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7107 BROOKSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1733
Mailing Address - Country:US
Mailing Address - Phone:443-690-2272
Mailing Address - Fax:
Practice Address - Street 1:5501 TWIN KNOLLS RD STE 107
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3260
Practice Address - Country:US
Practice Address - Phone:443-690-2272
Practice Address - Fax:855-450-1084
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR177957363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty