MEDICARE: KAYLA GOMEZ CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	367A00000X	Advanced Practice Midwife	APN.0998280-CNM	CO

General Provider Information

NPI Number	:	1477138824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA GOMEZ CNM

Provider Business Mailing Address
First Line	:	3803 MANCHESTER ST
Second Line	:
City	:	COLO SPGS
State	:	CO
Zip	:	80907-4828
Country	:	US
Telephone Number	:	719-428-5552
Fax Number	:

Provider Business Practice Location Address
First Line	:	3803 MANCHESTER ST
Second Line	:
City	:	COLO SPGS
State	:	CO
Zip	:	80907-4828
Country	:	US
Telephone Number	:	719-428-5552
Fax Number	:	719-687-9519

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2021
Last Update Date	:	12/14/2022

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Directions to “ KAYLA GOMEZ CNM” Practice Location

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