Healthcare Provider Details

I. General information

NPI: 1306551239
Provider Name (Legal Business Name): KAYLA SIBBLIES BSN, RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 01/16/2023
Certification Date: 01/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 WESTCROFT BLVD APT 411
CHANTILLY VA
20151-1554
US

IV. Provider business mailing address

4950 WESTCROFT BLVD APT 411
CHANTILLY VA
20151-1554
US

V. Phone/Fax

Practice location:
  • Phone: 903-600-0063
  • Fax:
Mailing address:
  • Phone: 903-600-0063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number0001316647
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-300779
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: