MEDICARE: KAILIN HAMILTON

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	174N00000X	Lactation Consultant (Non-RN)	L-86910	CO
2	133V00000X	Registered Dietitian	86022373	CO

General Provider Information

NPI Number	:	1336896075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAILIN HAMILTON

Provider Business Mailing Address
First Line	:	3109 BRYCE DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3119
Country	:	US
Telephone Number	:	281-435-4539
Fax Number	:

Provider Business Practice Location Address
First Line	:	3109 BRYCE DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3119
Country	:	US
Telephone Number	:	281-435-4539
Fax Number	:

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

Provider Enumeration Date	:	03/02/2022
Last Update Date	:	03/02/2022

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