MEDICARE: KAYLEIGH PUTNAM AU.D.

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	231H00000X	Audiologist	A-3624	NV

General Provider Information

NPI Number	:	1093492589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLEIGH PUTNAM AU.D.

Provider Business Mailing Address
First Line	:	501 S RANCHO DR STE A8
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4871
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 S RANCHO DR STE A8
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4871
Country	:	US
Telephone Number	:	702-605-9133
Fax Number	:

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

Provider Enumeration Date	:	06/28/2023
Last Update Date	:	06/28/2023

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