Healthcare Provider Details

I. General information

NPI: 1457537821
Provider Name (Legal Business Name): KAYLA EVANS LMBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10716 CARMEL COMMONS BLVD STE 130
CHARLOTTE NC
28226-3926
US

IV. Provider business mailing address

1067 HIDEAWAY LN APT 106
FORT MILL SC
29707-6101
US

V. Phone/Fax

Practice location:
  • Phone: 803-320-2065
  • Fax:
Mailing address:
  • Phone: 803-320-2065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number5416
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0667
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: