Healthcare Provider Details

I. General information

NPI: 1851128235
Provider Name (Legal Business Name): KAYLA DAWN COLBURN RN, PHN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 SATURN SKWY
REDDING CA
96002-2813
US

IV. Provider business mailing address

21779 BELMONT DR
PALO CEDRO CA
96073-8739
US

V. Phone/Fax

Practice location:
  • Phone: 530-224-4226
  • Fax: 530-224-4230
Mailing address:
  • Phone: 530-524-2354
  • Fax: 530-224-4230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number823521
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number823521
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: