Provider Demographics
NPI:1376235085
Name:GARY, KAYONIA NICOLE
Entity Type:Individual
Prefix:
First Name:KAYONIA
Middle Name:NICOLE
Last Name:GARY
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 1:3621 MARION LN
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-7579
Mailing Address - Country:US
Mailing Address - Phone:575-520-6074
Mailing Address - Fax:
Practice Address - Street 1:1408 SHADY TREE WAY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-2942
Practice Address - Country:US
Practice Address - Phone:530-906-3347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician