Provider Demographics
NPI:1649664392
Name:HALE, KAYLA MICHELLE (PA)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MICHELLE
Last Name:HALE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:MICHELLE
Other - Last Name:BADER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3033 NW 63RD ST STE 152E
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-3607
Mailing Address - Country:US
Mailing Address - Phone:405-755-6651
Mailing Address - Fax:405-755-2795
Practice Address - Street 1:13904 QUAILBROOK DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1718
Practice Address - Country:US
Practice Address - Phone:405-748-5950
Practice Address - Fax:405-607-3580
Is Sole Proprietor?:No
Enumeration Date:2015-03-20
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09642363AS0400X
OK2806363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical