Provider Demographics
NPI:1104428895
Name:MAYNE, KAIYA L
Entity type:Individual
Prefix:
First Name:KAIYA
Middle Name:L
Last Name:MAYNE
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 1:3901 BRISCOE RUN RD
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-0002
Mailing Address - Country:US
Mailing Address - Phone:304-422-0776
Mailing Address - Fax:
Practice Address - Street 1:3901 BRISCOE RUN RD
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-0002
Practice Address - Country:US
Practice Address - Phone:304-422-0776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV76814163WH0200X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide