MEDICARE: KAYLA HAVILL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95028136	CA
2	363LF0000X	Family Nurse Practitioner	0998572	CO
3	363LF0000X	Family Nurse Practitioner	71018032A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	24669	OTHER	SC	SC NP LICENSE
2	71018032A	OTHER	IN	NURSE PRACTITIONER
3	95028136	OTHER	CA	CALIFORNIA NP LICENSE
4	0998572	OTHER	CO	COLORADO NP LICENSE

General Provider Information

NPI Number	:	1275114704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA HAVILL

Provider Business Mailing Address
First Line	:	11901 RIDGE RD APT 565
Second Line	:
City	:	WHEAT RIDGE
State	:	CO
Zip	:	80033-2080
Country	:	US
Telephone Number	:	949-515-9300
Fax Number	:

Provider Business Practice Location Address
First Line	:	3920 S HILLCREST DR
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80237-1110
Country	:	US
Telephone Number	:	949-842-4580
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2021
Last Update Date	:	06/04/2026

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Directions to “ KAYLA HAVILL ” Practice Location

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