Healthcare Provider Details

I. General information

NPI: 1932033115
Provider Name (Legal Business Name): KAYLAH PAYNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 W TENNESSEE ST # 3208
TALLAHASSEE FL
32304-2505
US

IV. Provider business mailing address

2525 W TENNESSEE ST # 3208
TALLAHASSEE FL
32304-2505
US

V. Phone/Fax

Practice location:
  • Phone: 708-522-9068
  • Fax:
Mailing address:
  • Phone: 708-522-9068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberP500514058470
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: