Provider Demographics
NPI:1740140029
Name:FAHLENKAMP, MCKAYLA
Entity type:Individual
Prefix:
First Name:MCKAYLA
Middle Name:
Last Name:FAHLENKAMP
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 1:4475 325TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:FALL CITY
Mailing Address - State:WA
Mailing Address - Zip Code:98024-8707
Mailing Address - Country:US
Mailing Address - Phone:208-215-4463
Mailing Address - Fax:
Practice Address - Street 1:4475 325TH AVE SE
Practice Address - Street 2:
Practice Address - City:FALL CITY
Practice Address - State:WA
Practice Address - Zip Code:98024-8707
Practice Address - Country:US
Practice Address - Phone:208-215-4463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-18
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula