Provider Demographics
NPI:1952517591
Name:CARLSON, KYLA M (DO)
Entity Type:Individual
Prefix:
First Name:KYLA
Middle Name:M
Last Name:CARLSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KYLA
Other - Middle Name:M
Other - Last Name:CARMIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1611 ZIMMERMAN TRL
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-7652
Mailing Address - Country:US
Mailing Address - Phone:406-248-3607
Mailing Address - Fax:406-248-4881
Practice Address - Street 1:1611 ZIMMERMAN TRL
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-7652
Practice Address - Country:US
Practice Address - Phone:406-248-3607
Practice Address - Fax:406-248-4881
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT12775207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1952517591Medicaid
MTM011001373Medicare PIN