Provider Demographics
NPI:1205699600
Name:CHEATWOOD, KAYLIE ELISE
Entity type:Individual
Prefix:
First Name:KAYLIE
Middle Name:ELISE
Last Name:CHEATWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAYLIE
Other - Middle Name:ELISE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6893 S BLACK HILLS WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-7254
Mailing Address - Country:US
Mailing Address - Phone:209-770-4141
Mailing Address - Fax:
Practice Address - Street 1:2680 S VAL VISTA DR UNIT 15
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-2152
Practice Address - Country:US
Practice Address - Phone:209-770-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program