Healthcare Provider Details

I. General information

NPI: 1164388732
Provider Name (Legal Business Name): KAYLA NEAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 MCCORMICK PL
BROOKLET GA
30415-7802
US

IV. Provider business mailing address

104 MCCORMICK PL
BROOKLET GA
30415-7802
US

V. Phone/Fax

Practice location:
  • Phone: 912-677-7231
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP215391
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: