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DYLAN WADDILL
NPI 1932994597
Student in an Organized Health Care Education/Training Program in Pueblo, CO

Active since April 14, 2025PECOS Enrolled
902 LAKEVIEW AVE, PUEBLO, CO 81004(719) 557-5855(719) 557-5097 Get Directions Write a Review

NPPES record last updated: July 18, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dylan Waddill NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DYLAN WADDILL (NPI 1932994597) is an individual student in an organized health care education/training program in Pueblo, Colorado and active in the NPI registry since April 2025. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1932994597
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameDYLAN WADDILL
Location Address902 LAKEVIEW AVEPueblo, CO 81004-3597
Mailing Address902 Lakeview AvePueblo, CO 81004-3597
Phone(719) 557-5855
Fax(719) 557-5097
Sole ProprietorNo
Enumeration DateApril 14, 2025
Last NPPES UpdateJuly 18, 2025
NPPES CertifiedJuly 18, 2025
✔ NPI 1932994597 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
902 LAKEVIEW AVE, Pueblo, CO 81004
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dylan Waddill is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. CAMILA TERESA ROBLES DO
Family Medicine
902 LAKEVIEW AVE
PUEBLO, CO 81004
Pueblo County (719) 557-5872
MARK DAVIS PA-C
Physician Assistant
902 LAKEVIEW AVE
PUEBLO, CO 81004
Pueblo County (719) 557-5855
MADISON BASSETT
Student in an Organized Health Care Education/Training Program
902 LAKEVIEW AVE
PUEBLO, CO 81004
Pueblo County (719) 557-5855
REBECKA ANN REATHERFORD AGACNP-BC
Nurse Practitioner (Acute Care)
902 LAKEVIEW AVE
PUEBLO, CO 81004
Pueblo County (719) 557-5855
LUCINEI GERALDO STADNIK MD
Student in an Organized Health Care Education/Training Program
902 LAKEVIEW AVE
PUEBLO, CO 81004
Pueblo County (719) 557-5872
DR. LISA HAMILTON MD
Student in an Organized Health Care Education/Training Program
902 LAKEVIEW AVE
PUEBLO, CO 81004
Pueblo County (719) 557-5872
TIFFANY ANNE GARCIA FNP
Nurse Practitioner (Family)
902 LAKEVIEW AVE
PUEBLO, CO 81004
Pueblo County (719) 557-5855
DR. KIMBERLEY EVELYN JACKSON D.O.
General Practice
902 LAKEVIEW AVE
PUEBLO, CO 81004
Pueblo County (719) 557-5855

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Dylan Waddill's NPI number?

The NPI number for Dylan Waddill is 1932994597. It was assigned to this individual provider in the NPPES registry on April 14, 2025.

Where is Dylan Waddill located?

Dylan Waddill practices at 902 Lakeview Ave, Pueblo, CO 81004. The listed phone number is (719) 557-5855.

What is Dylan Waddill's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Dylan Waddill enrolled in Medicare?

Yes. Dylan Waddill is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Dylan Waddill was last updated on July 18, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.