Individual provider Active NPI

Katherine Anne Koller, PHD

  • Psychologist
  • Durham, NC
National Provider Identifier
1255122040
Registry record updated May 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
6719 Issued in NC
Practice address
2608 Erwin Rd
Durham, NC 27705-4596
Phone
(919) 385-3232
NPI assigned
May 13, 2025
Last updated
May 23, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 6719 NC Primary

Addresses

Primary practice location

2608 Erwin Rd
Durham, NC 27705-4596

Mailing address

4118 Amesbury LN
Durham, NC 27707-5708

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250626000408 NC Practitioner - Clinical Psychologist 5496267247 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
6719NCMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Duke Health Integrated Practice, Inc. CurrentSince Jul 1, 2025 Accepting new patients
Private Diagnostic Clinic, PLLC PastSince May 18, 2025 Accepting new patients

Locations

2608 Erwin Rd
Ste 300
Durham, NC 27705
Phone (919) 385-3232

40 Duke Medicine Cir
Durham, NC 27710
Phone (919) 681-6588

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1747094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747958400000",
    "number": "1255122040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4118 AMESBURY LN",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277075708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2608 ERWIN RD",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277054596",
            "telephone_number": "919-385-3232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLLER",
        "first_name": "KATHERINE",
        "middle_name": "ANNE",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-05-13",
        "last_updated": "2025-05-23",
        "certification_date": "2025-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "6719",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

Verify at the official NPI Registry.