Provider Demographics
NPI:1083402929
Name:NEEL-GRANT, KAYLA S
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:S
Last Name:NEEL-GRANT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:983 SONOMA AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4818
Mailing Address - Country:US
Mailing Address - Phone:707-529-3944
Mailing Address - Fax:
Practice Address - Street 1:983 SONOMA AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4818
Practice Address - Country:US
Practice Address - Phone:707-529-3944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker