MEDICARE: KAYLA SMITH

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	374700000X	Technician	RBT-21-193552	TX

General Provider Information

NPI Number	:	1417726191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA SMITH

Provider Business Mailing Address
First Line	:	6914 BRISBANE CT STE 200
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-4924
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4501 MAGNOLIA COVE DR STE 106A
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77345-2252
Country	:	US
Telephone Number	:	888-528-2931
Fax Number	:

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

Provider Enumeration Date	:	12/22/2023
Last Update Date	:	12/22/2023

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Directions to “ KAYLA SMITH ” Practice Location

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