Provider Demographics
NPI:1093337297
Name:SHEELEY, KAYLA
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:SHEELEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 E SKYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73047-9182
Mailing Address - Country:US
Mailing Address - Phone:918-978-6280
Mailing Address - Fax:
Practice Address - Street 1:13401 RAILWAY DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-2272
Practice Address - Country:US
Practice Address - Phone:405-841-7826
Practice Address - Fax:405-841-7827
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK02191991OtherDATE OF BIRTH