Provider Demographics
NPI:1598283541
Name:BURRIS, KAYLA DANIELLE (BA)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:DANIELLE
Last Name:BURRIS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-1392
Mailing Address - Country:US
Mailing Address - Phone:270-380-1601
Mailing Address - Fax:270-380-1602
Practice Address - Street 1:341 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-1392
Practice Address - Country:US
Practice Address - Phone:270-380-1601
Practice Address - Fax:270-380-1602
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator