Provider Demographics
NPI:1336334341
Name:YANCEY, KAYLA
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:YANCEY
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:HC 79 BOX 290
Mailing Address - Street 2:
Mailing Address - City:WIDEMAN
Mailing Address - State:AR
Mailing Address - Zip Code:72585-9705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HC 79 BOX 20
Practice Address - Street 2:
Practice Address - City:WIDEMAN
Practice Address - State:AR
Practice Address - Zip Code:72585-9700
Practice Address - Country:US
Practice Address - Phone:870-297-8349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant