Provider Demographics
NPI:1629662739
Name:BARCKLAY, KAYLA R
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:R
Last Name:BARCKLAY
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 1:1942 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-3416
Mailing Address - Country:US
Mailing Address - Phone:541-256-4696
Mailing Address - Fax:541-756-2111
Practice Address - Street 1:1942 SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-3416
Practice Address - Country:US
Practice Address - Phone:541-256-4696
Practice Address - Fax:541-756-2111
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1669886OtherODL