Provider Demographics
NPI:1003654328
Name:WILSON, KAYLA V
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:V
Last Name:WILSON
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 1:8035 E R L THORNTON FWY STE 242
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-7082
Mailing Address - Country:US
Mailing Address - Phone:469-984-6563
Mailing Address - Fax:
Practice Address - Street 1:8035 E R L THORNTON FWY STE 242
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-7082
Practice Address - Country:US
Practice Address - Phone:469-984-6563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health