Provider Demographics
NPI:1801555404
Name:SMITH, KAYLA EMILY (NONE)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:EMILY
Last Name:SMITH
Suffix:
Gender:F
Credentials:NONE
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 20310
Mailing Address - Street 2:UNIT #55984
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-7007
Mailing Address - Country:US
Mailing Address - Phone:307-257-5487
Mailing Address - Fax:
Practice Address - Street 1:859 S YELLOWSTONE HWY STE 202
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-5294
Practice Address - Country:US
Practice Address - Phone:307-257-5487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-10
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician