Provider Demographics
NPI:1124603469
Name:MATTHEWS, KAILA JANAI (CD)
Entity Type:Individual
Prefix:
First Name:KAILA
Middle Name:JANAI
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6783 STORNAWAY DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-7847
Mailing Address - Country:US
Mailing Address - Phone:901-603-3201
Mailing Address - Fax:
Practice Address - Street 1:6783 STORNAWAY DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-7847
Practice Address - Country:US
Practice Address - Phone:901-603-3201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN