Provider Demographics
NPI:1962704221
Name:SHAFFER, KAYLA L (BA, MHPP)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:L
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:BA, MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15968
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72231-5968
Mailing Address - Country:US
Mailing Address - Phone:501-221-1843
Mailing Address - Fax:501-221-2376
Practice Address - Street 1:405 N 2ND ST
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-2539
Practice Address - Country:US
Practice Address - Phone:501-843-3503
Practice Address - Fax:501-843-3504
Is Sole Proprietor?:No
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator