Healthcare Provider Details

I. General information

NPI: 1053220681
Provider Name (Legal Business Name): KYLA GORDON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 E RAWHIDE CT
GILBERT AZ
85296-2071
US

IV. Provider business mailing address

885 E RAWHIDE CT
GILBERT AZ
85296-2071
US

V. Phone/Fax

Practice location:
  • Phone: 928-446-5574
  • Fax:
Mailing address:
  • Phone: 928-446-5574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: