Healthcare Provider Details

I. General information

NPI: 1184469033
Provider Name (Legal Business Name): KAYLA N KEITH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLA N JOYCE

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 N. CHURCH STREET P.O. BOX 10467
GREENSBORO NC
27404-0467
US

IV. Provider business mailing address

630 HUNTCO DR APT 1803
CLARKSVILLE TN
37043-2377
US

V. Phone/Fax

Practice location:
  • Phone: 336-207-7005
  • Fax:
Mailing address:
  • Phone: 407-256-2895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: