Provider Demographics
NPI:1831735257
Name:LAROCQUE, KYLA MARIE
Entity type:Individual
Prefix:
First Name:KYLA
Middle Name:MARIE
Last Name:LAROCQUE
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:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:ND
Mailing Address - Zip Code:58367-0088
Mailing Address - Country:US
Mailing Address - Phone:701-477-9050
Mailing Address - Fax:701-477-8281
Practice Address - Street 1:102 MAIN AVE W
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:ND
Practice Address - Zip Code:58367
Practice Address - Country:US
Practice Address - Phone:701-477-9050
Practice Address - Fax:701-477-8281
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator