Healthcare Provider Details

I. General information

NPI: 1972207942
Provider Name (Legal Business Name): KAYLA JEANNE AUTHELET MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 E 31ST ST
OAKLAND CA
94602-1092
US

IV. Provider business mailing address

2112 8TH ST NW APT 913
WASHINGTON DC
20001-8215
US

V. Phone/Fax

Practice location:
  • Phone: 501-304-5259
  • Fax:
Mailing address:
  • Phone: 401-447-6374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA201448
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: