Provider Demographics
NPI:1609476878
Name:KALAMULA, KAITLYN MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MARIE
Last Name:KALAMULA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:MARIE
Other - Last Name:BOHUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:324 INVERNESS DR S APT 3105
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-6167
Mailing Address - Country:US
Mailing Address - Phone:303-549-3308
Mailing Address - Fax:
Practice Address - Street 1:9403 CROWN CREST BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8991
Practice Address - Country:US
Practice Address - Phone:303-269-2820
Practice Address - Fax:303-269-2829
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0006310363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant