Provider Demographics
NPI:1790010395
Name:VAHER, KAIRI (PSYD, NP)
Entity Type:Individual
Prefix:
First Name:KAIRI
Middle Name:
Last Name:VAHER
Suffix:
Gender:F
Credentials:PSYD, NP
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 560825
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80256-0825
Mailing Address - Country:US
Mailing Address - Phone:719-595-7580
Mailing Address - Fax:719-545-0176
Practice Address - Street 1:56 CLUB MANOR DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1685
Practice Address - Country:US
Practice Address - Phone:719-584-4767
Practice Address - Fax:719-595-7906
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2790103T00000X
CO184090163WP0809X
CO10011363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO34354841Medicaid
CO290851YK2DMedicare PIN