Provider Demographics
NPI:1568040392
Name:CHRISTIAN, KAYLEE
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:CHRISTIAN
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 1:272 GARRETTS BND
Mailing Address - Street 2:
Mailing Address - City:GRIFFITHSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25521-9726
Mailing Address - Country:US
Mailing Address - Phone:304-731-6112
Mailing Address - Fax:
Practice Address - Street 1:272 GARRETTS BND
Practice Address - Street 2:
Practice Address - City:GRIFFITHSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25521-9726
Practice Address - Country:US
Practice Address - Phone:304-731-6112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker