Provider Demographics
NPI:1306462676
Name:COOMER, KAYLA M (BCBA)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:M
Last Name:COOMER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8735 OLD BARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291
Mailing Address - Country:US
Mailing Address - Phone:502-208-6650
Mailing Address - Fax:866-822-2607
Practice Address - Street 1:8735 OLD BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291
Practice Address - Country:US
Practice Address - Phone:502-208-6650
Practice Address - Fax:866-822-2607
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY103K00000X
KY264597103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100678090Medicaid