Healthcare Provider Details

I. General information

NPI: 1114604246
Provider Name (Legal Business Name): KAITLYN ANN COYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 06/30/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2503 E LYON STATION RD
CREEDMOOR NC
27522
US

IV. Provider business mailing address

1137 HIDDEN HILLS DRIVE
WAKE FOREST NC
27587
US

V. Phone/Fax

Practice location:
  • Phone: 919-528-1535
  • Fax:
Mailing address:
  • Phone: 724-681-4693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5018341
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5018341
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5018341
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: