Provider Demographics
NPI:1760821169
Name:MATTHEWS, KAYLA RENEE (DO)
Entity Type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:RENEE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3506 GREENLEAF LODGE LN
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-6028
Mailing Address - Country:US
Mailing Address - Phone:814-795-6929
Mailing Address - Fax:
Practice Address - Street 1:6431 FANNIN ST
Practice Address - Street 2:SUITE MSB 5.196
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-500-6223
Practice Address - Fax:713-500-6270
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO 3703208D00000X
TXR1823207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice