Provider Demographics
NPI:1083487961
Name:WALLACE, KAILA (DOULA)
Entity Type:Individual
Prefix:
First Name:KAILA
Middle Name:
Last Name:WALLACE
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12685 DORSETT RD # 405
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-2100
Mailing Address - Country:US
Mailing Address - Phone:314-252-1933
Mailing Address - Fax:
Practice Address - Street 1:3407 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-3119
Practice Address - Country:US
Practice Address - Phone:314-252-1933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula