Healthcare Provider Details

I. General information

NPI: 1154234599
Provider Name (Legal Business Name): KAYLIN MARIE HUGHBANKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 EAGLERIDGE BLVD STE 140
PUEBLO CO
81008-2354
US

IV. Provider business mailing address

805 EAGLERIDGE BLVD STE 140
PUEBLO CO
81008-2354
US

V. Phone/Fax

Practice location:
  • Phone: 719-679-5022
  • Fax: 719-888-1673
Mailing address:
  • Phone: 719-679-5022
  • Fax: 719-888-1673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWC.0000001968
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: