Healthcare Provider Details

I. General information

NPI: 1457711400
Provider Name (Legal Business Name): KAYLA FRANK CDM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11700 E JENNY CIR
PALMER AK
99645-9358
US

IV. Provider business mailing address

11700 E JENNY CIR
PALMER AK
99645-9358
US

V. Phone/Fax

Practice location:
  • Phone: 907-315-8766
  • Fax:
Mailing address:
  • Phone: 907-315-8766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number108157
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: