Provider Demographics
NPI:1053811026
Name:HAMILTON, KAYLA DENEA (LVN)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:DENEA
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10714 LONE PINE LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-3764
Mailing Address - Country:US
Mailing Address - Phone:817-204-8515
Mailing Address - Fax:
Practice Address - Street 1:8624 FUNTIER CT
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-2837
Practice Address - Country:US
Practice Address - Phone:817-204-8515
Practice Address - Fax:817-204-8515
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX221526164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse