Provider Demographics
NPI:1700288552
Name:LEZAK, KAYLA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:
Last Name:LEZAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 COUNTY ROAD 424
Mailing Address - Street 2:
Mailing Address - City:EL CAMPO
Mailing Address - State:TX
Mailing Address - Zip Code:77437-7158
Mailing Address - Country:US
Mailing Address - Phone:979-541-9932
Mailing Address - Fax:
Practice Address - Street 1:1041 US 59 HIGHWAY SUITE A
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488
Practice Address - Country:US
Practice Address - Phone:979-245-2008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant