Healthcare Provider Details

I. General information

NPI: 1952050312
Provider Name (Legal Business Name): KAYLA SUE WHITLEY DNP, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 JAMES ST
GRAY GA
31032-6358
US

IV. Provider business mailing address

147 JAMES ST
GRAY GA
31032-6358
US

V. Phone/Fax

Practice location:
  • Phone: 478-405-0045
  • Fax:
Mailing address:
  • Phone: 478-405-0045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberRN239403
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: