Provider Demographics
NPI:1205633849
Name:COREY, KYLA ELIZABETH
Entity type:Individual
Prefix:
First Name:KYLA
Middle Name:ELIZABETH
Last Name:COREY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 ELSINORE DR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-5508
Mailing Address - Country:US
Mailing Address - Phone:707-816-1888
Mailing Address - Fax:
Practice Address - Street 1:378 ELSINORE DR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-5508
Practice Address - Country:US
Practice Address - Phone:707-816-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-01
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator