1922550227 NPI number — MRS. KAYLA CHRISTINE YATES KHOURY MS, ATC, CEAS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922550227 NPI number — MRS. KAYLA CHRISTINE YATES KHOURY MS, ATC, CEAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHOURY
Provider First Name:
KAYLA
Provider Middle Name:
CHRISTINE YATES
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, ATC, CEAS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SQUIRES
Provider Other First Name:
KAYLA
Provider Other Middle Name:
CHRISTINE YATES
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, ATC, CEAS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922550227
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5555 E BRIARWOOD AVE APT 2002
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTENNIAL
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80122-4805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-289-5112
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3801 BRIGHTON BLVD
Provider Second Line Business Practice Location Address:
WELLNESS CENTER
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80216-3625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-299-4528
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/03/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  AT.0000931 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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