Provider Demographics
NPI:1609645688
Name:SPAIN, KAYLA (SRNA)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:SPAIN
Suffix:
Gender:F
Credentials:SRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 COURT SQ STE A
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-1418
Mailing Address - Country:US
Mailing Address - Phone:606-236-9615
Mailing Address - Fax:
Practice Address - Street 1:410 COURT SQ STE A
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-1418
Practice Address - Country:US
Practice Address - Phone:606-236-9615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY50167793376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide