MEDICARE: KAITLYN ROSE CHAVIRA

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

General Provider Information

NPI Number	:	1619713864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN ROSE CHAVIRA

Provider Business Mailing Address
First Line	:	2402 UNIVERSITY DR
Second Line	:
City	:	KEARNEY
State	:	NE
Zip	:	68849-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2402 UNIVERSITY DR
Second Line	:
City	:	KEARNEY
State	:	NE
Zip	:	68849-0001
Country	:	US
Telephone Number	:	720-315-2820
Fax Number	:

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

Provider Enumeration Date	:	07/08/2024
Last Update Date	:	07/08/2024

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Directions to “ KAITLYN ROSE CHAVIRA ” Practice Location

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