Healthcare Provider Details

I. General information

NPI: 1770311805
Provider Name (Legal Business Name): KYLIE BRIANNE VANLANDINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PRINCETON AVE SW
BIRMINGHAM AL
35211-1303
US

IV. Provider business mailing address

PO BOX 11407, DEPT 8388
BIRMINGHAM AL
35246-8388
US

V. Phone/Fax

Practice location:
  • Phone: 205-977-1949
  • Fax: 412-822-7411
Mailing address:
  • Phone: 412-822-7410
  • Fax: 412-822-7411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2692
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: