Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 54306 | CO |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 54306 | CO |
NPI | 1700176708 |
---|---|
Provider Name | Kaylin A Klie |
First Address | Aurora, CO 80042-0429 |
Second Address | Aurora, CO 80045-2545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2011 |
Last Update Date | 25/10/2018 |