Provider Demographics
NPI:1205323490
Name:SHEARER, KAYLA SUSANN (LPN)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:SUSANN
Last Name:SHEARER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17702-7038
Mailing Address - Country:US
Mailing Address - Phone:570-660-0336
Mailing Address - Fax:570-666-3958
Practice Address - Street 1:1545 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:SOUTH WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17702-7038
Practice Address - Country:US
Practice Address - Phone:570-660-0336
Practice Address - Fax:570-666-3958
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA33733601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health