Provider Demographics
NPI:1235974973
Name:LEWIS, KYLA RENEE
Entity type:Individual
Prefix:
First Name:KYLA
Middle Name:RENEE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 S BLUFF ST
Mailing Address - Street 2:
Mailing Address - City:CATOOSA
Mailing Address - State:OK
Mailing Address - Zip Code:74015-2011
Mailing Address - Country:US
Mailing Address - Phone:918-803-6568
Mailing Address - Fax:
Practice Address - Street 1:204 S BLUFF ST
Practice Address - Street 2:
Practice Address - City:CATOOSA
Practice Address - State:OK
Practice Address - Zip Code:74015-2011
Practice Address - Country:US
Practice Address - Phone:918-803-6568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator