Healthcare Provider Details

I. General information

NPI: 1982538740
Provider Name (Legal Business Name): KAYLA PETERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S MONTGOMERY AVE
SHEFFIELD AL
35660-6334
US

IV. Provider business mailing address

715 VOLUNTEER DR
TUSCUMBIA AL
35674-3123
US

V. Phone/Fax

Practice location:
  • Phone: 256-386-4592
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-184072
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: