Provider Demographics
NPI:1295353936
Name:MCKENZIE, KAYLA FAYLYN NICOLE
Entity type:Individual
Prefix:MS
First Name:KAYLA
Middle Name:FAYLYN NICOLE
Last Name:MCKENZIE
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 1:1905 SOUTHERN DRIVE
Mailing Address - Street 2:UNIT 1905A
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201
Mailing Address - Country:US
Mailing Address - Phone:903-526-9337
Mailing Address - Fax:
Practice Address - Street 1:1905 SOUTHERN DRIVE
Practice Address - Street 2:UNIT 1905A
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201
Practice Address - Country:US
Practice Address - Phone:903-526-9337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer