Healthcare Provider Details

I. General information

NPI: 1508738691
Provider Name (Legal Business Name): KAYLA NICOLE ROBERTS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 ROSS CLARK CIR STE 400
DOTHAN AL
36301-4770
US

IV. Provider business mailing address

1450 ROSS CLARK CIRCLE SUITE 400
DOTHAN AL
36301
US

V. Phone/Fax

Practice location:
  • Phone: 334-305-0400
  • Fax: 334-305-0401
Mailing address:
  • Phone: 334-305-0400
  • Fax: 334-305-0401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3-002701
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number11041231
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: