NPIMap

Individual provider Active NPI

Katherine Shepherd Anderson, ACNP- BC

  • Acute Care Nurse Practitioner
  • Colleyville, TX
National Provider Identifier
1730710641
Registry record updated Jan 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
0001890 Issued in CO
Practice address
2205 Collins Path
Colleyville, TX 76034-7325
Phone
(703) 485-6110
NPI assigned
Jan 29, 2020
Last updated
Jan 29, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 29, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 0001890 CO Primary

Addresses

Primary practice location

2205 Collins Path
Colleyville, TX 76034-7325

Mailing address

2205 Collins Path
Colleyville, TX 76034-7325
Phone (703) 485-6110

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200504000139 CO Practitioner - Nurse Practitioner 2961833181 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1050 Wellington Ave
Imh Wellington Lung and Sleep Clinic
Grand Junction, CO 81501-8121
Phone (970) 298-5864

201 W Park Dr
201 West Park Cardiology
Grand Junction, CO 81505-1469
Phone (970) 298-3050

2635 N 7TH St
Grand Junction, CO 81501-8209

2686 Patterson Rd
Grand Junction, CO 81506-8817
Phone (970) 298-2001

360 W Park Dr
Intermountain Health Heart and Vascular Wes
Grand Junction, CO 81505-1448
Phone (970) 298-3050

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0001890COMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Intermountain Medical Group Grand Junction, LLC CurrentSince Apr 21, 2020 Accepting new patients
Intermountain Medical Group Grand Junction, LLC CurrentSince Apr 21, 2020 Accepting new patients
St Mary's Hospital and Medical Center, Inc Past Accepting new patients
St Mary's Hospital and Medical Center, Inc Past Accepting new patients

Locations

1050 Wellington Ave
Grand Junction, CO 81501
Phone (970) 245-4810

1050 Wellington Ave
Slp Ctr
Grand Junction, CO 81501
Phone (970) 298-5864

2643 Patterson Rd
Ste 403
Grand Junction, CO 81506
Phone (970) 298-7662

360 W Park Dr
Grand Junction, CO 81505
Phone (970) 244-2482

Interoperability endpoints

  • Direct secure messaging: katherine.anderson.1@26283.direct.athenahealth.com

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1580256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580256000000",
    "number": "1730710641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2205 COLLINS PATH",
            "city": "COLLEYVILLE",
            "state": "TX",
            "postal_code": "760347325",
            "telephone_number": "703-485-6110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2205 COLLINS PATH",
            "city": "COLLEYVILLE",
            "state": "TX",
            "postal_code": "760347325",
            "telephone_number": "703-485-6110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "KATHERINE",
        "middle_name": "SHEPHERD",
        "credential": "ACNP- BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-01-29",
        "last_updated": "2020-01-29",
        "certification_date": "2020-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CO",
            "license": "0001890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colleyville, TX

Sources for this page

Verify at the official NPI Registry.