Healthcare Provider Details

I. General information

NPI: 1528830171
Provider Name (Legal Business Name): MS. KAYLA RENEE ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2023
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 CLIFTON RD NE
ATLANTA GA
30322-4201
US

IV. Provider business mailing address

2116 LUNCEFORD LN SW
LILBURN GA
30047-4752
US

V. Phone/Fax

Practice location:
  • Phone: 404-727-7980
  • Fax:
Mailing address:
  • Phone: 646-300-5253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN-NP295693
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: