Healthcare Provider Details

I. General information

NPI: 1053258178
Provider Name (Legal Business Name): KAYLA EASTHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 COLEGATE DR
MARIETTA OH
45750-9549
US

IV. Provider business mailing address

316 PAHLHURST PLZ
PARKERSBURG WV
26101-7621
US

V. Phone/Fax

Practice location:
  • Phone: 304-210-5244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number41145
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: