Provider Demographics
NPI:1679951487
Name:WILDE, KATHRYN ELIZABETH (WHNP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ELIZABETH
Last Name:WILDE
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6071 E WOODMEN RD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-2614
Mailing Address - Country:US
Mailing Address - Phone:719-442-0808
Mailing Address - Fax:719-622-3400
Practice Address - Street 1:6071 E WOODMEN RD
Practice Address - Street 2:SUITE 405
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2614
Practice Address - Country:US
Practice Address - Phone:719-442-0808
Practice Address - Fax:719-622-3400
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0991565363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health