Provider Demographics
NPI:1477138824
Name:GOMEZ, KAYLA (CNM)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3803 MANCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:COLO SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-4828
Mailing Address - Country:US
Mailing Address - Phone:719-428-5552
Mailing Address - Fax:
Practice Address - Street 1:3803 MANCHESTER ST
Practice Address - Street 2:
Practice Address - City:COLO SPGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4828
Practice Address - Country:US
Practice Address - Phone:719-428-5552
Practice Address - Fax:719-687-9519
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
COAPN.0998280-CNM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program