Provider Demographics
NPI:1912413790
Name:DESHANE, KAYLA LINDSEY (LAC)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:LINDSEY
Last Name:DESHANE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:LINDSEY
Other - Last Name:STOKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11400 DOMAIN DR APT 5327
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-7742
Mailing Address - Country:US
Mailing Address - Phone:214-417-4462
Mailing Address - Fax:
Practice Address - Street 1:5901 OLD FREDERICKSBURG RD STE A103
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1210
Practice Address - Country:US
Practice Address - Phone:512-636-3956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-16
Last Update Date:2017-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist