Healthcare Provider Details

I. General information

NPI: 1295558773
Provider Name (Legal Business Name): KAYLYN WADLEY M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 ARLINGTON BLVD STE 510
FALLS CHURCH VA
22042-2325
US

IV. Provider business mailing address

2250 DOCK LN APT 1507
ALEXANDRIA VA
22314-6277
US

V. Phone/Fax

Practice location:
  • Phone: 571-425-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: