MEDICARE: KAYLIN LYLES

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	374J00000X	Doula

General Provider Information

NPI Number	:	1437912292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLIN LYLES

Provider Business Mailing Address
First Line	:	5548 MABLE AVE APT B2
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63140-1437
Country	:	US
Telephone Number	:	314-482-0289
Fax Number	:

Provider Business Practice Location Address
First Line	:	5548 MABLE AVE APT B2
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63140-1437
Country	:	US
Telephone Number	:	314-482-0289
Fax Number	:

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

Provider Enumeration Date	:	02/05/2024
Last Update Date	:	02/05/2024

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Directions to “ KAYLIN LYLES ” Practice Location

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