Healthcare Provider Details

I. General information

NPI: 1134911514
Provider Name (Legal Business Name): MCKAYLYNN HUMES CST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 EXEMPLA CIR
LAFAYETTE CO
80026-3370
US

IV. Provider business mailing address

2422 SHOOTING STAR WAY
EVANS CO
80620-9245
US

V. Phone/Fax

Practice location:
  • Phone: 303-689-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License NumberST.0006998
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: