Provider Demographics
NPI:1336365386
Name:FUTRELL, KYLA N (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KYLA
Middle Name:N
Last Name:FUTRELL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:KYLA
Other - Middle Name:NICOLE
Other - Last Name:STARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4105 COVINGTON DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-9455
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 SOUTHWEST SQ
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5984
Practice Address - Country:US
Practice Address - Phone:870-336-0220
Practice Address - Fax:870-336-0221
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#2361235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5R204OtherAR BCBS
AR157767721Medicaid