Provider Demographics
NPI:1447057773
Name:COBURN, KAYLA RAE'NAE
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:RAE'NAE
Last Name:COBURN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7210 S YALE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-6319
Mailing Address - Country:US
Mailing Address - Phone:918-310-1489
Mailing Address - Fax:
Practice Address - Street 1:7210 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6319
Practice Address - Country:US
Practice Address - Phone:918-310-1489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist