Provider Demographics
NPI:1144065228
Name:CHURCH, KATHARINE SELINA (NP)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:SELINA
Last Name:CHURCH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 HOVER RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-4141
Mailing Address - Country:US
Mailing Address - Phone:720-278-8567
Mailing Address - Fax:
Practice Address - Street 1:26 W DRY CREEK CIR STE 710
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-8065
Practice Address - Country:US
Practice Address - Phone:303-801-1776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0999896-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health