Healthcare Provider Details

I. General information

NPI: 1962220509
Provider Name (Legal Business Name): KAYLEIGH NICOLE REPAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 CHAPPELL DR
RALEIGH NC
27606-3299
US

IV. Provider business mailing address

739 CHAPPELL DR
RALEIGH NC
27606-3299
US

V. Phone/Fax

Practice location:
  • Phone: 919-832-3909
  • Fax: 919-755-7421
Mailing address:
  • Phone: 919-832-3909
  • Fax: 919-755-7421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: