Katelyn Miranda Deveraux, is a medicare enrolled "Student In An Organized Health Care Education/training Program" physician in Pueblo, Colorado. Her current practice location is
902 Lakeview Ave, Pueblo, Colorado. You can reach out to her office (for appointments etc.) via phone at
(719) 557-5855.
Katelyn Miranda Deveraux is licensed to practice in Colorado (license number TL.0008870) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1386225522.
Physician's Profile
Full Name | Katelyn Miranda Deveraux |
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Gender | Female |
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Speciality | Student In An Organized Health Care Education/training Program |
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Location | 902 Lakeview Ave, Pueblo, Colorado |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1386225522
- Provider Enumeration Date: 04/19/2021
- Last Update Date: 04/17/2023
Medicare PECOS Information:
- PECOS PAC ID: 7113328105
- Enrollment ID: I20210628003591
Medical Identifiers
Medical identifiers for Katelyn Miranda Deveraux such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1386225522 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
207Q00000X | Family Medicine | TL.0008870 (Colorado) | Secondary |
208D00000X | General Practice | DR.0069707 (Colorado) | Secondary |
390200000X | Student In An Organized Health Care Education/training Program | TL.0008870 (Colorado) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Katelyn Miranda Deveraux is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Katelyn Miranda Deveraux, 902 Lakeview Ave, Pueblo, CO 81004-3597 Ph: () - | Katelyn Miranda Deveraux, 902 Lakeview Ave, Pueblo, CO 81004-3597 Ph: (719) 557-5855 |
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