1275175689 NPI number — KAYLA MASIKA ULMER-DELOACH APRN

Table of content: KAYLA MASIKA ULMER-DELOACH APRN (NPI 1275175689)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275175689 NPI number — KAYLA MASIKA ULMER-DELOACH APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ULMER-DELOACH
Provider First Name:
KAYLA
Provider Middle Name:
MASIKA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275175689
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1106 4TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33403-2637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-331-0852
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10140 FOREST HILL BLVD STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLINGTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33414-6111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-287-5622
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN294164 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: APRN11004554 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)