Healthcare Provider Details

I. General information

NPI: 1457120107
Provider Name (Legal Business Name): YVETTE CAROL KUYKENDOLL-GASTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2023
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13957 E IDAHO DR
AURORA CO
80012-5576
US

IV. Provider business mailing address

PO BOX 441398
AURORA CO
80044-1398
US

V. Phone/Fax

Practice location:
  • Phone: 720-495-0534
  • Fax:
Mailing address:
  • Phone: 720-495-0534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number481896
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number0122074
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: