Healthcare Provider Details

I. General information

NPI: 1609770023
Provider Name (Legal Business Name): KAYLEIGH ANNA DARST
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 N ACADEMY ST
GREENVILLE SC
29601-2629
US

IV. Provider business mailing address

29 BLYTHEWOOD DR
GREENVILLE SC
29607-1201
US

V. Phone/Fax

Practice location:
  • Phone: 864-331-1363
  • Fax: 864-522-9572
Mailing address:
  • Phone: 864-551-8542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP.9839SPIN
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: