Provider Demographics
NPI:1285489377
Name:PARKS, KAYLA AUDREY
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:AUDREY
Last Name:PARKS
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 1:529 WRENCROFT CT
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-8009
Mailing Address - Country:US
Mailing Address - Phone:513-316-5881
Mailing Address - Fax:
Practice Address - Street 1:529 WRENCROFT CT
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-8009
Practice Address - Country:US
Practice Address - Phone:513-316-5881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist