MEDICARE: KAYLA GAY

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
2	106S00000X	Behavior Technician	RBT-23-293484	AR

General Provider Information

NPI Number	:	1780297507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA GAY

Provider Business Mailing Address
First Line	:	PO BOX 1589
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72018-1589
Country	:	US
Telephone Number	:	501-315-3344
Fax Number	:

Provider Business Practice Location Address
First Line	:	4610 W COMMERCIAL DR
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7057
Country	:	US
Telephone Number	:	501-287-5229
Fax Number	:

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

Provider Enumeration Date	:	08/31/2020
Last Update Date	:	09/14/2023

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Directions to “ KAYLA GAY ” Practice Location

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