Provider Demographics
NPI:1023331477
Name:PROCHODA, FREDI SHAE (DNP,MSN, FNP, FPMHNP)
Entity type:Individual
Prefix:DR
First Name:FREDI
Middle Name:SHAE
Last Name:PROCHODA
Suffix:
Gender:F
Credentials:DNP,MSN, FNP, FPMHNP
Other - Prefix:
Other - First Name:ESTHER
Other - Middle Name:ALFREDA
Other - Last Name:BECKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, FNP, FPMHNP
Mailing Address - Street 1:591 MILLS RANCH RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-9460
Mailing Address - Country:US
Mailing Address - Phone:303-881-8598
Mailing Address - Fax:
Practice Address - Street 1:6950 E BELLEVIEW AVE STE 300
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-1629
Practice Address - Country:US
Practice Address - Phone:303-468-8018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO177837163W00000X
CORXP-100158363L00000X
CO6013363LF0000X
CONP-6013363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO21102384OtherMEDICAID GROUP NUMBER
CO38303787Medicaid