Provider Demographics
NPI:1194362376
Name:PERKINS, KAYLA RENEE
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:RENEE
Last Name:PERKINS
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 1:3240 GROVELAND WAY
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-4931
Mailing Address - Country:US
Mailing Address - Phone:916-904-6014
Mailing Address - Fax:
Practice Address - Street 1:3240 GROVELAND WAY
Practice Address - Street 2:
Practice Address - City:ANTELOPE
Practice Address - State:CA
Practice Address - Zip Code:95843-4931
Practice Address - Country:US
Practice Address - Phone:916-904-6014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA09124025OtherKAISER