Provider Demographics
NPI:1033891122
Name:ROSS, MCKAYLA M
Entity Type:Individual
Prefix:
First Name:MCKAYLA
Middle Name:M
Last Name:ROSS
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 1:338 W 300 N STE 1
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84318-4044
Mailing Address - Country:US
Mailing Address - Phone:435-774-4113
Mailing Address - Fax:
Practice Address - Street 1:338 W 300 N STE 1
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:UT
Practice Address - Zip Code:84318-4044
Practice Address - Country:US
Practice Address - Phone:435-774-4113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program