Provider Demographics
NPI:1023560190
Name:THORNGATE, KAYLA (RDN, IBCLC)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:THORNGATE
Suffix:
Gender:F
Credentials:RDN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SUNLIGHT LN
Mailing Address - Street 2:
Mailing Address - City:BAILEY
Mailing Address - State:CO
Mailing Address - Zip Code:80421-2300
Mailing Address - Country:US
Mailing Address - Phone:970-673-7103
Mailing Address - Fax:
Practice Address - Street 1:16 SUNLIGHT LN
Practice Address - Street 2:
Practice Address - City:BAILEY
Practice Address - State:CO
Practice Address - Zip Code:80421-2300
Practice Address - Country:US
Practice Address - Phone:970-673-7103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COL-150011174N00000X
CO1107967133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174N00000XOther Service ProvidersLactation Consultant, Non-RN