Provider Demographics
NPI:1548739527
Name:MAXEY, KYLA ANN (BS, OBHP)
Entity Type:Individual
Prefix:
First Name:KYLA
Middle Name:ANN
Last Name:MAXEY
Suffix:
Gender:F
Credentials:BS, OBHP
Other - Prefix:
Other - First Name:KYLA
Other - Middle Name:ANN
Other - Last Name:FULWIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:415 N 26TH ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2895
Mailing Address - Country:US
Mailing Address - Phone:765-362-2852
Mailing Address - Fax:
Practice Address - Street 1:415 N 26TH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2895
Practice Address - Country:US
Practice Address - Phone:765-362-2852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator