Healthcare Provider Details

I. General information

NPI: 1649745654
Provider Name (Legal Business Name): KYLA ELAINE MOORE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KYLA ELAINE BLOUIN APRN

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E BOULDER ST STE 500
COLORADO SPRINGS CO
80909-5533
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 719-364-6487
  • Fax: 719-364-6488
Mailing address:
  • Phone: 719-364-6487
  • Fax: 719-364-6488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPN.0996891-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number116172
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: