Healthcare Provider Details

I. General information

NPI: 1205794385
Provider Name (Legal Business Name): KAYLA EASLEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 J L WHITE DR STE 140B
JASPER GA
30143-4896
US

IV. Provider business mailing address

134 MOUNT PISGAH DR
ELLIJAY GA
30540-8208
US

V. Phone/Fax

Practice location:
  • Phone: 706-692-9016
  • Fax:
Mailing address:
  • Phone: 706-273-0265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN215376
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: