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General NPI Number Information
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NPI Number | 1912413790
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Entity Type | Individual
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Provider Name | KAYLA LINDSEY DESHANE L.AC.
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Gender | Female
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Dates
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Enumeration Date | 12/16/2017
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Last Update Date | 12/16/2017
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Provider Practice Location Address
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Address Line | 5901 OLD FREDERICKSBURG RD STE A103
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City | AUSTIN
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State | TX
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Zip | 78749-1210
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Country | US
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Telephone | 512-636-3956
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Fax |
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Provider Business Mailing Address
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Address Line | 11400 DOMAIN DR APT 5327
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City | AUSTIN
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State | TX
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Zip | 78758-7742
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Country | US
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Telephone | 214-417-4462
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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