Provider Demographics
NPI:1588289904
Name:GRAY, KATELYN (RN,BSN,PMHNP)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:RN,BSN,PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 17TH ST UNIT 2376
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1508
Mailing Address - Country:US
Mailing Address - Phone:915-336-2125
Mailing Address - Fax:720-680-3420
Practice Address - Street 1:1312 17TH ST UNIT 2376
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-1508
Practice Address - Country:US
Practice Address - Phone:915-336-2125
Practice Address - Fax:720-680-3420
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0998228-NP363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health