Provider Demographics
NPI:1790515740
Name:SURBER, KAYLAH MARIE
Entity type:Individual
Prefix:
First Name:KAYLAH
Middle Name:MARIE
Last Name:SURBER
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 1:232 CIRCLEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-9337
Mailing Address - Country:US
Mailing Address - Phone:301-237-5459
Mailing Address - Fax:
Practice Address - Street 1:232 CIRCLEVIEW DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-9337
Practice Address - Country:US
Practice Address - Phone:301-237-5459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant