MEDICARE: KAYLA ROEHLING

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	363A00000X	Physician Assistant	PA.0004555	CO

General Provider Information

NPI Number	:	1487016176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA ROEHLING

Provider Business Mailing Address
First Line	:	4104 TEJON ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-1813
Country	:	US
Telephone Number	:	303-381-3700
Fax Number	:

Provider Business Practice Location Address
First Line	:	4104 TEJON ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-1813
Country	:	US
Telephone Number	:	303-381-3700
Fax Number	:

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

Provider Enumeration Date	:	03/22/2016
Last Update Date	:	03/22/2016

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Directions to “ KAYLA ROEHLING ” Practice Location

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