Healthcare Provider Details

I. General information

NPI: 1972267268
Provider Name (Legal Business Name): KAYLA EVETTE HAIRSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2021
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3027 PISGAH PL APT D
GREENSBORO NC
27455-3284
US

IV. Provider business mailing address

3027 PISGAH PL APT D
GREENSBORO NC
27455-3284
US

V. Phone/Fax

Practice location:
  • Phone: 743-255-6488
  • Fax:
Mailing address:
  • Phone: 743-255-6488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP024502
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: