Healthcare Provider Details

I. General information

NPI: 1174272462
Provider Name (Legal Business Name): MCKAYLA SEYMOUR DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 GODWIN BLVD, ATTN: RICHARD BRUNO SUITE 355
SUFFOLK VA
23434
US

IV. Provider business mailing address

23473 SEYMOUR LN
EPWORTH IA
52045-9615
US

V. Phone/Fax

Practice location:
  • Phone: 757-983-8520
  • Fax:
Mailing address:
  • Phone: 563-451-6541
  • 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: