Healthcare Provider Details

I. General information

NPI: 1336085521
Provider Name (Legal Business Name): KAYLA CONYERS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 W ENTERPRISE AVE
MUNCIE IN
47304-5839
US

IV. Provider business mailing address

2101 W ENTERPRISE AVE
MUNCIE IN
47304-5839
US

V. Phone/Fax

Practice location:
  • Phone: 765-896-7140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: