Provider Demographics
NPI:1770334716
Name:PEINE, KAYLA REBECCA (PA)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:REBECCA
Last Name:PEINE
Suffix:
Gender:F
Credentials:PA
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 460757
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:UT
Mailing Address - Zip Code:84746-0757
Mailing Address - Country:US
Mailing Address - Phone:435-705-3593
Mailing Address - Fax:
Practice Address - Street 1:191 N VALLEY RD
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:UT
Practice Address - Zip Code:84746-0757
Practice Address - Country:US
Practice Address - Phone:435-705-3593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program