Provider Demographics
NPI:1760849616
Name:LUCHAN, KAYLA R
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:R
Last Name:LUCHAN
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 1:111 LAKE HOLLINGSWORTH DR
Mailing Address - Street 2:15179
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-5607
Mailing Address - Country:US
Mailing Address - Phone:330-770-5438
Mailing Address - Fax:
Practice Address - Street 1:111 LAKE HOLLINGSWORTH DR
Practice Address - Street 2:15179
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5607
Practice Address - Country:US
Practice Address - Phone:330-770-5438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-23
Last Update Date:2016-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program