| Doctor Name: | KAYLA BAKANE |
| NPI Number: | 1124490073 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | |
| Business Practice Address: | 4351 Booth Calloway Rd Suite 101 North Richland Hills, TX - 761807378 |
| Business Phone Number: | 8172841165 |
| Business Fax Number: | 8172842677 |
| Mailing Address: | 4351 Booth Calloway Rd, Suite 101 NORTH RICHLAND HILLS |
| State: | TX |
| Postal Code: | 761807378 |
| Phone Number: | 8172841165 |
| Fax Number: | 8172842677 |
| NPI Enumeration Date: | 10/29/2015 |
| NPI Last Update Date: | 10/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |