Provider Demographics
NPI:1649554569
Name:VONGLAHN, KAYLYN (PA)
Entity type:Individual
Prefix:
First Name:KAYLYN
Middle Name:
Last Name:VONGLAHN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26659 PLEASANT PARK RD
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-7768
Mailing Address - Country:US
Mailing Address - Phone:303-647-5280
Mailing Address - Fax:877-892-7288
Practice Address - Street 1:26659 PLEASANT PARK RD
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-7768
Practice Address - Country:US
Practice Address - Phone:303-647-5280
Practice Address - Fax:877-892-7288
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00004395363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical