MEDICARE: KAYLA ROSS-CARR

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1700353281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA ROSS-CARR

Provider Business Mailing Address
First Line	:	912 NW 104TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73114-5529
Country	:	US
Telephone Number	:	602-558-5671
Fax Number	:

Provider Business Practice Location Address
First Line	:	912 NW 104TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73114-5529
Country	:	US
Telephone Number	:	602-558-5671
Fax Number	:

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

Provider Enumeration Date	:	11/01/2018
Last Update Date	:	11/01/2018

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Directions to “ KAYLA ROSS-CARR ” Practice Location

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