Provider Demographics
NPI:1508064635
Name:LARA, KIRSTEN JEANNE (RN, LAC)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:JEANNE
Last Name:LARA
Suffix:
Gender:F
Credentials:RN, LAC
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:JEANNE
Other - Last Name:KAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:4523 E BENNINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-8771
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4523 E BENNINGTON AVE
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-8771
Practice Address - Country:US
Practice Address - Phone:303-325-6692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1625522163W00000X
CO1240171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No171100000XOther Service ProvidersAcupuncturist