Healthcare Provider Details

I. General information

NPI: 1831995752
Provider Name (Legal Business Name): ALAYNE KITTLE RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2025
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 9
PEMBROKE GA
31321-0009
US

IV. Provider business mailing address

114 SPOTTED FAWN RD S
STATESBORO GA
30461-0749
US

V. Phone/Fax

Practice location:
  • Phone: 912-653-4331
  • Fax:
Mailing address:
  • Phone: 812-327-1065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN324969
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: