Provider Demographics
NPI:1366260317
Name:SKINNER, KYLA R
Entity type:Individual
Prefix:
First Name:KYLA
Middle Name:R
Last Name:SKINNER
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 1:923 ARKBLACK TER
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-3689
Mailing Address - Country:US
Mailing Address - Phone:505-331-9857
Mailing Address - Fax:
Practice Address - Street 1:2410 EVERGREEN RD STE 100
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-2070
Practice Address - Country:US
Practice Address - Phone:410-451-8150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program