Provider Demographics
NPI:1396221362
Name:KIELAS, ALICIA (APN, FNP-C, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:KIELAS
Suffix:
Gender:F
Credentials:APN, FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8191
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-8191
Mailing Address - Country:US
Mailing Address - Phone:719-246-4925
Mailing Address - Fax:
Practice Address - Street 1:226 1/2 S UNION AVE UNIT 205
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3557
Practice Address - Country:US
Practice Address - Phone:719-246-4925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-12
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0993991-NP363LF0000X
CO0993991363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily