Provider Demographics
NPI:1780945774
Name:MASON, KAYLA MICHELLE
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MICHELLE
Last Name:MASON
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 1:33 PARK CIR
Mailing Address - Street 2:
Mailing Address - City:EVENING SHADE
Mailing Address - State:AR
Mailing Address - Zip Code:72532-9330
Mailing Address - Country:US
Mailing Address - Phone:870-269-4321
Mailing Address - Fax:
Practice Address - Street 1:33 PARK CIR
Practice Address - Street 2:
Practice Address - City:EVENING SHADE
Practice Address - State:AR
Practice Address - Zip Code:72532-9330
Practice Address - Country:US
Practice Address - Phone:870-269-4321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist