Provider Demographics
NPI:1164140711
Name:LEE, KAYLA MASHELLE
Entity Type:Individual
Prefix:MS
First Name:KAYLA
Middle Name:MASHELLE
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:MASHELLE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7301 W 34TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107-4528
Mailing Address - Country:US
Mailing Address - Phone:918-813-9442
Mailing Address - Fax:
Practice Address - Street 1:7301 W 34TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74107-4528
Practice Address - Country:US
Practice Address - Phone:918-813-9442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator