Healthcare Provider Details

I. General information

NPI: 1598283541
Provider Name (Legal Business Name): KAYLA DANIELLE BURRIS BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 08/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 OFFICE PARK DR
COLUMBIA KY
42728-1392
US

IV. Provider business mailing address

341 OFFICE PARK DR
COLUMBIA KY
42728-1392
US

V. Phone/Fax

Practice location:
  • Phone: 270-380-1601
  • Fax: 270-380-1602
Mailing address:
  • Phone: 270-380-1601
  • Fax: 270-380-1602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: