Provider Demographics
NPI:1790595502
Name:NEWSOME, KAYLISHA LASHAWN
Entity type:Individual
Prefix:
First Name:KAYLISHA
Middle Name:LASHAWN
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAYLISHA
Other - Middle Name:LASHAWN
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26803 JOY AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-6130
Mailing Address - Country:US
Mailing Address - Phone:402-769-8741
Mailing Address - Fax:
Practice Address - Street 1:26803 JOY AVE
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74014-6130
Practice Address - Country:US
Practice Address - Phone:402-769-8741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator