Provider Demographics
NPI:1013599604
Name:GREGORY, KAYLENE LORRAINE
Entity Type:Individual
Prefix:
First Name:KAYLENE
Middle Name:LORRAINE
Last Name:GREGORY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948-1651
Mailing Address - Country:US
Mailing Address - Phone:509-865-5121
Mailing Address - Fax:
Practice Address - Street 1:511 S ELM ST
Practice Address - Street 2:
Practice Address - City:TOPPENISH
Practice Address - State:WA
Practice Address - Zip Code:98948-1651
Practice Address - Country:US
Practice Address - Phone:509-865-5121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-23
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program