Healthcare Provider Details

I. General information

NPI: 1346910957
Provider Name (Legal Business Name): KYLA HENNIGAN CNM, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E MOUNTAIN BLVD
WILKES BARRE PA
18711-0027
US

IV. Provider business mailing address

134 DORAN DR
SHAVERTOWN PA
18708-1613
US

V. Phone/Fax

Practice location:
  • Phone: 570-808-7300
  • Fax:
Mailing address:
  • Phone: 570-899-5749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberMW010823
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberSP030763
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: