Healthcare Provider Details

I. General information

NPI: 1740115997
Provider Name (Legal Business Name): KAILA SUE SHOEMAKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAILA SUE SMITH

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 LITTLE BLUFF CV
VANCLEAVE MS
39565-7399
US

IV. Provider business mailing address

6701 LITTLE BLUFF CV
VANCLEAVE MS
39565-7399
US

V. Phone/Fax

Practice location:
  • Phone: 228-365-8339
  • Fax:
Mailing address:
  • Phone: 228-365-8339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number3942
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: