Provider Demographics
NPI:1821540931
Name:DUNKIN, KAYLA MARIE
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:MARIE
Last Name:DUNKIN
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 1:1503 SCHULTS AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:CARUTHERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63830-2479
Mailing Address - Country:US
Mailing Address - Phone:573-333-5875
Mailing Address - Fax:
Practice Address - Street 1:915 HIGHWAY 84 W
Practice Address - Street 2:
Practice Address - City:CARUTHERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63830-8113
Practice Address - Country:US
Practice Address - Phone:573-333-5875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker