Healthcare Provider Details

I. General information

NPI: 1043999667
Provider Name (Legal Business Name): KAYLA LOUISE YAZZIE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 07/12/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 SW HOLDEN ST
SEATTLE WA
98126-3505
US

IV. Provider business mailing address

PO BOX 2209
CHINO VALLEY AZ
86323-2209
US

V. Phone/Fax

Practice location:
  • Phone: 206-248-8226
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number61411834
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: