Healthcare Provider Details

I. General information

NPI: 1336135961
Provider Name (Legal Business Name): KAYLA MASON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAYLA GILL

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 KENTUCKY AVE DRS BLDG 3 SUITE 501
PADUCAH KY
42003-3800
US

IV. Provider business mailing address

2605 KENTUCKY AVE DRS BLDG 3 SUITE 501
PADUCAH KY
42003-3800
US

V. Phone/Fax

Practice location:
  • Phone: 270-744-9600
  • Fax:
Mailing address:
  • Phone: 270-744-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number28040
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: