Provider Demographics
NPI:1861762973
Name:NEWLAND, KAYLEEN L (PA-C)
Entity type:Individual
Prefix:
First Name:KAYLEEN
Middle Name:L
Last Name:NEWLAND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KAYLEEN
Other - Middle Name:L
Other - Last Name:VAN BUSKIRK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3008 S GILPIN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-6319
Mailing Address - Country:US
Mailing Address - Phone:303-916-1392
Mailing Address - Fax:
Practice Address - Street 1:15464 EAST ORCHARD ROAD
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80016
Practice Address - Country:US
Practice Address - Phone:303-680-5437
Practice Address - Fax:303-680-5439
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3272363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical