Healthcare Provider Details

I. General information

NPI: 1154064517
Provider Name (Legal Business Name): KAYLA MYREN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 19TH AVE STE 6000
DENVER CO
80218-1293
US

IV. Provider business mailing address

1601 E 19TH AVE STE 6000
DENVER CO
80218-1293
US

V. Phone/Fax

Practice location:
  • Phone: 303-861-7001
  • Fax:
Mailing address:
  • Phone: 303-861-7001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPN.0997508-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number997508
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: