Healthcare Provider Details

I. General information

NPI: 1588551147
Provider Name (Legal Business Name): KAYLA WHITLOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 09/08/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E HAMLET ST
PINETOPS NC
27864
US

IV. Provider business mailing address

3444 BRIARCLIFF DR APT E
GREENVILLE NC
27834-5419
US

V. Phone/Fax

Practice location:
  • Phone: 252-827-2116
  • Fax:
Mailing address:
  • Phone: 908-528-4441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number30004162
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: