Provider Demographics
NPI:1205600210
Name:BUCKLEW, KAYLA NICOLE
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:NICOLE
Last Name:BUCKLEW
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 1:1184 SARAH FREEMAN DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-4986
Mailing Address - Country:US
Mailing Address - Phone:937-546-6171
Mailing Address - Fax:
Practice Address - Street 1:1184 SARAH FREEMAN DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-4986
Practice Address - Country:US
Practice Address - Phone:937-546-6171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program