Provider Demographics
NPI:1396496295
Name:KILLIFER, KAYLA BRIEANNE (PA-C)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:BRIEANNE
Last Name:KILLIFER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 MALLECK ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:TX
Mailing Address - Zip Code:78934-1925
Mailing Address - Country:US
Mailing Address - Phone:505-793-4272
Mailing Address - Fax:
Practice Address - Street 1:2122 STATE HWY 71
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:TX
Practice Address - Zip Code:78934-2364
Practice Address - Country:US
Practice Address - Phone:979-733-0095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15451363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant