Provider Demographics
NPI:1336715705
Name:FLESHMAN, CAYLA MAE (PA)
Entity Type:Individual
Prefix:
First Name:CAYLA
Middle Name:MAE
Last Name:FLESHMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CAYLA
Other - Middle Name:
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:803-791-2000
Mailing Address - Fax:
Practice Address - Street 1:146 E HOSPITAL DR STE 550
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4843
Practice Address - Country:US
Practice Address - Phone:803-936-7410
Practice Address - Fax:803-936-7412
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMPA.3950363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4786PAMedicaid