Provider Demographics
NPI:1609862986
Name:HESTER, KAYLA DIANE (RPH)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:DIANE
Last Name:HESTER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 MIDLOTHIAN PKWY S.
Mailing Address - Street 2:STE 140
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065
Mailing Address - Country:US
Mailing Address - Phone:972-723-5500
Mailing Address - Fax:972-723-5503
Practice Address - Street 1:1441 MIDLOTHIAN PWKY
Practice Address - Street 2:STE 140
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065
Practice Address - Country:US
Practice Address - Phone:972-723-5500
Practice Address - Fax:972-723-5503
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23175183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145392Medicaid
TX23175OtherSTATE LIC#
4510827OtherNCPDP#
4510827OtherNCPDP#