Healthcare Provider Details

I. General information

NPI: 1720962145
Provider Name (Legal Business Name): KAYLE STANLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 BELLEVIEW AVE SE
ROANOKE VA
24014-1838
US

IV. Provider business mailing address

70 GRAYSON ST
ROCKY MOUNT VA
24151-6508
US

V. Phone/Fax

Practice location:
  • Phone: 540-487-7101
  • Fax:
Mailing address:
  • Phone: 540-420-1669
  • Fax: 540-420-1669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-302453
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: