Healthcare Provider Details

I. General information

NPI: 1699631200
Provider Name (Legal Business Name): KAYLA PRESTINE NORRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2025
Last Update Date: 12/27/2025
Certification Date: 12/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

552 W 3RD ST
MANSFIELD OH
44906-2633
US

IV. Provider business mailing address

552 W 3RD ST
MANSFIELD OH
44906-2633
US

V. Phone/Fax

Practice location:
  • Phone: 419-771-0882
  • Fax: 419-771-0882
Mailing address:
  • Phone: 419-771-0882
  • Fax: 419-771-0882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.007264
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: