Provider Demographics
NPI:1598222077
Name:GENCO, KYLEIGH GRACE
Entity Type:Individual
Prefix:
First Name:KYLEIGH
Middle Name:GRACE
Last Name:GENCO
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 1:19239 LORANGER TRCE
Mailing Address - Street 2:
Mailing Address - City:LORANGER
Mailing Address - State:LA
Mailing Address - Zip Code:70446-2303
Mailing Address - Country:US
Mailing Address - Phone:985-351-0466
Mailing Address - Fax:
Practice Address - Street 1:19239 LORANGER TRCE
Practice Address - Street 2:
Practice Address - City:LORANGER
Practice Address - State:LA
Practice Address - Zip Code:70446-2303
Practice Address - Country:US
Practice Address - Phone:985-351-0466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program