Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 13660 | TX |
NPI | 1013995778 |
---|---|
Provider Name | Kay Lyn Ness |
First Address | Colorado Springs, CO 80921-3236 |
Second Address | U S A F Academy, CO 80840-2502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD-000 | (02) |