Provider Demographics
NPI:1669824306
Name:GAYLE, JAYA (ACAT)
Entity Type:Individual
Prefix:
First Name:JAYA
Middle Name:
Last Name:GAYLE
Suffix:
Gender:F
Credentials:ACAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 S MCPHERSON CHURCH RD STE A
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5369
Mailing Address - Country:US
Mailing Address - Phone:910-286-4784
Mailing Address - Fax:
Practice Address - Street 1:5047 VIRGINIA AVE
Practice Address - Street 2:BLDG 500
Practice Address - City:FORT LEONARD WOOD
Practice Address - State:MO
Practice Address - Zip Code:65473-9126
Practice Address - Country:US
Practice Address - Phone:573-596-0408
Practice Address - Fax:573-596-0314
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-06
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No126800000XDental ProvidersDental Assistant