Provider Demographics
NPI:1558081471
Name:BERG, KAYLA JEAN
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:JEAN
Last Name:BERG
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 1:707 PONDEROSA VLG
Mailing Address - Street 2:
Mailing Address - City:BURNS
Mailing Address - State:OR
Mailing Address - Zip Code:97720-2315
Mailing Address - Country:US
Mailing Address - Phone:541-610-9287
Mailing Address - Fax:
Practice Address - Street 1:348 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:BURNS
Practice Address - State:OR
Practice Address - Zip Code:97720-1710
Practice Address - Country:US
Practice Address - Phone:541-610-9287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker