Individual
KYRA K HOOTMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2001 LAKE AVE, PUEBLO, CO 81004-3535
(719) 564-0300
(719) 564-0303
Mailing address
2001 LAKE AVE, PUEBLO, CO 81004-3535
(719) 564-0300
(719) 564-0303
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
38729
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
62781847
—
CO
Enumeration date
05/09/2006
Last updated
08/13/2008
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