Healthcare Provider Details

I. General information

NPI: 1699520064
Provider Name (Legal Business Name): KAYLA ROOKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6071 W OUTER DR
DETROIT MI
48235-2624
US

IV. Provider business mailing address

20223 WEYHER ST
LIVONIA MI
48152-2083
US

V. Phone/Fax

Practice location:
  • Phone: 313-966-1020
  • Fax:
Mailing address:
  • Phone: 586-431-1312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: