MEDICARE: KAYLA PARKER

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	246RM2200X	Medical Laboratory Technician

General Provider Information

NPI Number	:	1063120939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA PARKER

Provider Business Mailing Address
First Line	:	13854 LAKESIDE CIR STE 528
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48313-1443
Country	:	US
Telephone Number	:	586-544-4394
Fax Number	:	586-544-4395

Provider Business Practice Location Address
First Line	:	13854 LAKESIDE CIR STE 528
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48313-1443
Country	:	US
Telephone Number	:	586-544-4394
Fax Number	:	586-544-4395

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

Provider Enumeration Date	:	11/09/2022
Last Update Date	:	11/09/2022

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Directions to “ KAYLA PARKER ” Practice Location

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