=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225843543
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BUTTERFLY & BLOSSOM PSYCHIATRY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2025
-----------------------------------------------------
Last Update Date | 06/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 112 W D ST UNIT 210B
-----------------------------------------------------
City | PUEBLO
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81003-3461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-280-2268
-----------------------------------------------------
Fax | 866-308-1780
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 220 W ORMAN AVE
-----------------------------------------------------
City | PUEBLO
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81004-1838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-252-3182
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KAYLA VARELA
-----------------------------------------------------
Credential | PMHNP-BC
-----------------------------------------------------
Telephone | 719-252-3182
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------