Healthcare Provider Details

I. General information

NPI: 1922829084
Provider Name (Legal Business Name): KAYLA PHIPPS SYKES CPNP AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

112 MEADOW POINTE CV
BRANDON MS
39042-5013
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-4027
  • Fax:
Mailing address:
  • Phone: 601-466-6811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number906990
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: