Provider Demographics
NPI:1679449532
Name:TYLER, KAELA RENEE
Entity type:Individual
Prefix:
First Name:KAELA
Middle Name:RENEE
Last Name:TYLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:LA PUSH
Mailing Address - State:WA
Mailing Address - Zip Code:98350-0189
Mailing Address - Country:US
Mailing Address - Phone:360-374-6984
Mailing Address - Fax:360-374-9049
Practice Address - Street 1:560 QUILEUTE HEIGHTS
Practice Address - Street 2:
Practice Address - City:LAPUSH
Practice Address - State:WA
Practice Address - Zip Code:98331
Practice Address - Country:US
Practice Address - Phone:360-374-6984
Practice Address - Fax:360-374-9049
Is Sole Proprietor?:No
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA25-0004-DHAT125J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125J00000XDental ProvidersDental Therapist