Provider Demographics
NPI:1760029763
Name:MORELAND-LAW, KAYANNA KAYLYNN (CMA)
Entity Type:Individual
Prefix:
First Name:KAYANNA
Middle Name:KAYLYNN
Last Name:MORELAND-LAW
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15806 4TH AVE S D-105
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98148-2547
Mailing Address - Country:US
Mailing Address - Phone:206-742-1199
Mailing Address - Fax:
Practice Address - Street 1:15806 4TH AVE S D-105
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-2547
Practice Address - Country:US
Practice Address - Phone:206-742-1199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2020-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No374700000XNursing Service Related ProvidersTechnician