Provider Demographics
NPI:1790494359
Name:LUYSTER, KAYLA DANAE
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:DANAE
Last Name:LUYSTER
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 1:636 CLIFF ST NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44647-4238
Mailing Address - Country:US
Mailing Address - Phone:330-880-3435
Mailing Address - Fax:
Practice Address - Street 1:2421 13TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-3116
Practice Address - Country:US
Practice Address - Phone:330-452-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator