Healthcare Provider Details

I. General information

NPI: 1396654299
Provider Name (Legal Business Name): KATELYN YADAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6255 SAWCUT PT
FOUNTAIN CO
80817-1867
US

IV. Provider business mailing address

6675 MANDAN DR
COLORADO SPRINGS CO
80925-8454
US

V. Phone/Fax

Practice location:
  • Phone: 719-359-9080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA.0025727
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: