Provider Demographics
NPI:1740718873
Name:COLVILL, KAYLA (MD)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:COLVILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 ELM ST APT 4207
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75202-2928
Mailing Address - Country:US
Mailing Address - Phone:713-515-8977
Mailing Address - Fax:
Practice Address - Street 1:1325 PENNSYLVANIA AVE STE 560
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2152
Practice Address - Country:US
Practice Address - Phone:817-250-7240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT3060208600000X
TXBP10060956208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery