Healthcare Provider Details

I. General information

NPI: 1770879108
Provider Name (Legal Business Name): KAYLIN SPENCE CORLEY WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MEDICAL CENTER DR SUITE 4A
ALEXANDRIA LA
71301-8124
US

IV. Provider business mailing address

501 MEDICAL CENTER DR SUITE 4A
ALEXANDRIA LA
71301-8124
US

V. Phone/Fax

Practice location:
  • Phone: 318-442-5800
  • Fax: 318-442-1109
Mailing address:
  • Phone: 318-442-5800
  • Fax: 318-442-1109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP06509
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: