Healthcare Provider Details

I. General information

NPI: 1689286262
Provider Name (Legal Business Name): KAYLA DAWN METZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HUNTERS MOUNTAIN PKWY
TROY AL
36079-5895
US

IV. Provider business mailing address

PO BOX 130
WETUMPKA AL
36092-0003
US

V. Phone/Fax

Practice location:
  • Phone: 334-465-7056
  • Fax: 833-696-0057
Mailing address:
  • Phone: 334-567-4311
  • Fax: 334-514-3686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-134380
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: