Provider Demographics
NPI:1144511445
Name:COLVIN, KAREN W (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:W
Last Name:COLVIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7876
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-0876
Mailing Address - Country:US
Mailing Address - Phone:719-547-8803
Mailing Address - Fax:719-547-8806
Practice Address - Street 1:125 W PALMER LAKE DR
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-2876
Practice Address - Country:US
Practice Address - Phone:719-547-8803
Practice Address - Fax:719-547-8806
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO346662080P0006X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000151800Medicaid
CO80986226Medicaid