Provider Demographics
NPI:1487058376
Name:RAINBOLT, KAYLEN NOEL
Entity type:Individual
Prefix:
First Name:KAYLEN
Middle Name:NOEL
Last Name:RAINBOLT
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 1:2455 N WHITEWATER CLUB DR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4017
Mailing Address - Country:US
Mailing Address - Phone:503-481-2250
Mailing Address - Fax:
Practice Address - Street 1:77824 WILDCAT DR
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-1134
Practice Address - Country:US
Practice Address - Phone:760-237-8070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2024-06-19
Deactivation Date:2022-09-08
Deactivation Code:
Reactivation Date:2022-09-23
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management