Provider Demographics
NPI:1861995789
Name:MCCLOUD, KATIE A (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:A
Last Name:MCCLOUD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2470 PATTERSON RD STE 8
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1028
Mailing Address - Country:US
Mailing Address - Phone:970-245-6911
Mailing Address - Fax:
Practice Address - Street 1:2470 PATTERSON RD STE 8
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1028
Practice Address - Country:US
Practice Address - Phone:702-456-9119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9111168207Q00000X, 2084P0800X
CO25462120000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry