Provider Demographics
NPI:1558167999
Name:FREDRICK, KAILA
Entity type:Individual
Prefix:
First Name:KAILA
Middle Name:
Last Name:FREDRICK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 E MOUNTAIN VALE WAY
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:UT
Mailing Address - Zip Code:84653-2024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:65 E MOUNTAIN VALE WAY
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:UT
Practice Address - Zip Code:84653-2024
Practice Address - Country:US
Practice Address - Phone:385-895-6944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula