MEDICARE: KAYLA SIFORD PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0110008397	VA

General Provider Information

NPI Number	:	1225796469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA SIFORD PA-C

Provider Business Mailing Address
First Line	:	PO BOX 776084
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6084
Country	:	US
Telephone Number	:	314-372-3420
Fax Number	:

Provider Business Practice Location Address
First Line	:	9180 W FLORISSANT AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-1421
Country	:	US
Telephone Number	:	314-372-3420
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2021
Last Update Date	:	06/06/2023

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