Provider Demographics
NPI:1255685558
Name:HYDER, KAYLA BETH (BSW)
Entity Type:Individual
Prefix:MISS
First Name:KAYLA
Middle Name:BETH
Last Name:HYDER
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5645
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-5645
Mailing Address - Country:US
Mailing Address - Phone:423-631-0141
Mailing Address - Fax:423-631-0157
Practice Address - Street 1:2408 SUSANNAH ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-1748
Practice Address - Country:US
Practice Address - Phone:423-631-0141
Practice Address - Fax:423-631-0157
Is Sole Proprietor?:No
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator