Provider Demographics
NPI:1457014474
Name:SEYMOUR, KAYLEE NICOLE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MISS
First Name:KAYLEE
Middle Name:NICOLE
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
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Mailing Address - Street 1:4226 FM 3012 RD
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-8137
Mailing Address - Country:US
Mailing Address - Phone:979-533-3941
Mailing Address - Fax:
Practice Address - Street 1:620 W LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1508
Practice Address - Country:US
Practice Address - Phone:979-533-3941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-17
Last Update Date:2021-10-17
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant