MEDICARE: KAYLA SUE MAHURIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1033858899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA SUE MAHURIN

Provider Business Mailing Address
First Line	:	1 UNIVERSITY RD
Second Line	:
City	:	PEMBROKE
State	:	NC
Zip	:	28372-7613
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	32 FOREST LAKE DR
Second Line	:
City	:	JACKSON SPRINGS
State	:	NC
Zip	:	27281-9745
Country	:	US
Telephone Number	:	573-330-9728
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2022
Last Update Date	:	05/31/2022

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