Provider Demographics
NPI:1184006256
Name:MASSIE, KAYLA MARIE
Entity Type:Individual
Prefix:MS
First Name:KAYLA
Middle Name:MARIE
Last Name:MASSIE
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 1:1210 EASTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5134
Mailing Address - Country:US
Mailing Address - Phone:830-379-9308
Mailing Address - Fax:
Practice Address - Street 1:1210 EASTWOOD DR
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5134
Practice Address - Country:US
Practice Address - Phone:830-379-9308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program