Healthcare Provider Details

I. General information

NPI: 1861762973
Provider Name (Legal Business Name): KAYLEEN L NEWLAND PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAYLEEN L VAN BUSKIRK

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15464 EAST ORCHARD ROAD
CENTENNIAL CO
80016
US

IV. Provider business mailing address

3008 S GILPIN ST
DENVER CO
80210-6319
US

V. Phone/Fax

Practice location:
  • Phone: 303-680-5437
  • Fax: 303-680-5439
Mailing address:
  • Phone: 303-916-1392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3272
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: