Healthcare Provider Details

I. General information

NPI: 1043188899
Provider Name (Legal Business Name): KAYLIE STURICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2025
Last Update Date: 10/24/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 GA-26
COCHRAN GA
31014
US

IV. Provider business mailing address

366 GA-26
COCHRAN GA
31014
US

V. Phone/Fax

Practice location:
  • Phone: 478-934-2874
  • Fax:
Mailing address:
  • Phone: 478-934-2874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN312951
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: