Healthcare Provider Details

I. General information

NPI: 1255816922
Provider Name (Legal Business Name): KAYLA CHERRY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLA SMITH

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MALL RD
BURLINGTON MA
01805-3395
US

IV. Provider business mailing address

LAHEY PROVIDER ENROLLMENT DEPARTMENT 41 MALL ROAD
BURLINGTON MA
01805-0001
US

V. Phone/Fax

Practice location:
  • Phone: 781-744-8085
  • Fax:
Mailing address:
  • Phone: 781-744-8085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA6640
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: