Provider Demographics
NPI:1861193070
Name:MCSHERRY, KAYLA FAITH
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:FAITH
Last Name:MCSHERRY
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 1:500 RESERVE CIR APT 138
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-4673
Mailing Address - Country:US
Mailing Address - Phone:618-477-9305
Mailing Address - Fax:
Practice Address - Street 1:8 EXECUTIVE DR STE 200
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-1350
Practice Address - Country:US
Practice Address - Phone:618-688-4727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program