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NPI Code Detail

MEDICARE: KAYLA SKINNER PHD

MEDICARE: KAYLA SKINNER PHD
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
1103TC0700XClinical Psychologist0810006291VA
2103TC0700XClinical Psychologist2020026173MO

General Provider Information

NPI Number : 1700383114
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAYLA SKINNER PHD
Provider Business Mailing Address
First Line : PO BOX 936
Second Line :
City : NORFOLK
State : VA
Zip : 23501-0936
Country : US
Telephone Number : 757-446-5888
Fax Number : 757-446-5918
Provider Business Practice Location Address
First Line : 2458 OLD DORSETT RD STE 110
Second Line :
City : MARYLAND HEIGHTS
State : MO
Zip : 63043-2423
Country : US
Telephone Number : 636-939-2550
Fax Number : 636-939-2551
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2018
Last Update Date : 12/10/2024

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