Provider Demographics
NPI:1235525346
Name:EORY, KAIDEN (LSA)
Entity Type:Individual
Prefix:MS
First Name:KAIDEN
Middle Name:
Last Name:EORY
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-5604
Mailing Address - Country:US
Mailing Address - Phone:214-227-2457
Mailing Address - Fax:
Practice Address - Street 1:1901 MILLER RD
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-5604
Practice Address - Country:US
Practice Address - Phone:214-227-2457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-15
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX161596246ZC0007X
TXSA00650246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant