Healthcare Provider Details

I. General information

NPI: 1326854753
Provider Name (Legal Business Name): KAYLA DANIELLE STATON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1073 MEDICAL RIDGE RD
CLINTON SC
29325-4542
US

IV. Provider business mailing address

300 E MCBEE AVE STE 300
GREENVILLE SC
29601-2899
US

V. Phone/Fax

Practice location:
  • Phone: 864-833-3557
  • Fax: 864-833-7724
Mailing address:
  • Phone: 864-522-8611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number29896
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: