Healthcare Provider Details

I. General information

NPI: 1992051270
Provider Name (Legal Business Name): KADIJATU KAKAY DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2012
Last Update Date: 10/25/2020
Certification Date: 10/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIRCLE
FORT CARSON CO
80913
US

IV. Provider business mailing address

1650 COCHRANE CIR
FORT CARSON CO
80913-4613
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-6767
  • Fax:
Mailing address:
  • Phone: 719-526-6767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0994700-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: