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General NPI Number Information
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NPI Number | 1023560190
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Entity Type | Individual
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Provider Name | KAYLA THORNGATE RDN, IBCLC
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Gender | Female
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Dates
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Enumeration Date | 10/25/2016
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Last Update Date | 04/14/2022
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Provider Practice Location Address
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Address Line | 16 SUNLIGHT LN
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City | BAILEY
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State | CO
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Zip | 80421-2300
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Country | US
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Telephone | 970-673-7103
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Fax |
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Provider Business Mailing Address
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Address Line | 16 SUNLIGHT LN
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City | BAILEY
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State | CO
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Zip | 80421-2300
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Country | US
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Telephone | 970-673-7103
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number | L-150011
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 1107967
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License Number State | CO
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