Provider Demographics
NPI:1194322933
Name:FOXWORTH, KAYLA ELISE
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:ELISE
Last Name:FOXWORTH
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 1:4070 SUMRALL LN
Mailing Address - Street 2:
Mailing Address - City:VILLAGE MILLS
Mailing Address - State:TX
Mailing Address - Zip Code:77663
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4070 SUMRALL LN
Practice Address - Street 2:
Practice Address - City:VILLAGE MILLS
Practice Address - State:TX
Practice Address - Zip Code:77663
Practice Address - Country:US
Practice Address - Phone:409-200-1476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX328193164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse