Healthcare Provider Details

I. General information

NPI: 1952266447
Provider Name (Legal Business Name): KYLA CHEAMA BA, LSAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 339
ZUNI NM
87327
US

IV. Provider business mailing address

PO BOX 339
ZUNI NM
87327
US

V. Phone/Fax

Practice location:
  • Phone: 505-782-5719
  • Fax: 505-782-5735
Mailing address:
  • Phone: 505-782-5719
  • Fax: 505-782-5735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberCTB-2023-0594
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: