Provider Demographics
NPI:1699663138
Name:PINA, KYLIE (RN, BSN, IBCLC)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:PINA
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 MILLSTREAM TER
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-4217
Mailing Address - Country:US
Mailing Address - Phone:515-290-9255
Mailing Address - Fax:
Practice Address - Street 1:379 MILLSTREAM TER
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-4217
Practice Address - Country:US
Practice Address - Phone:515-290-9255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COL-319106163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant