Provider Demographics
NPI:1124738406
Name:LOWER, KAYLA LYNN
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:LYNN
Last Name:LOWER
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 1:605 WILDERNESS DR
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-5230
Mailing Address - Country:US
Mailing Address - Phone:307-281-1008
Mailing Address - Fax:
Practice Address - Street 1:605 WILDERNESS DR
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-5230
Practice Address - Country:US
Practice Address - Phone:307-281-1008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health