Provider Demographics
NPI:1023855855
Name:CASON, KAYLA N (CNA204242)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:N
Last Name:CASON
Suffix:
Gender:F
Credentials:CNA204242
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:NICOLE
Other - Last Name:BRIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12790 COUNTY ROAD 136
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32060-6361
Mailing Address - Country:US
Mailing Address - Phone:386-339-7532
Mailing Address - Fax:386-269-4285
Practice Address - Street 1:12790 COUNTY ROAD 136
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32060-6361
Practice Address - Country:US
Practice Address - Phone:386-339-7532
Practice Address - Fax:386-269-4285
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CNA204242261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center