Provider Demographics
NPI:1376282129
Name:WHITEHEAD, KAYLA JEAN (MSW)
Entity type:Individual
Prefix:MS
First Name:KAYLA
Middle Name:JEAN
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 N CARPENTER RD STE B
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351-1185
Mailing Address - Country:US
Mailing Address - Phone:916-764-0232
Mailing Address - Fax:
Practice Address - Street 1:2616 WHITMER CT
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95358-1238
Practice Address - Country:US
Practice Address - Phone:209-523-4573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No171M00000XOther Service ProvidersCase Manager/Care Coordinator