Healthcare Provider Details

I. General information

NPI: 1700229655
Provider Name (Legal Business Name): CAITLIN ANN KIELTYKA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAITLIN ANN REXSES M.D.

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2860 S CIRCLE DR FL 4
COLORADO SPRINGS CO
80906-4113
US

IV. Provider business mailing address

2860 S CIRCLE DR FL 4
COLORADO SPRINGS CO
80906-4113
US

V. Phone/Fax

Practice location:
  • Phone: 719-540-2146
  • Fax:
Mailing address:
  • Phone: 719-540-2146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR1797
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDR.0056198
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: