Healthcare Provider Details

I. General information

NPI: 1407780158
Provider Name (Legal Business Name): KAYLA KING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 LEE STREET, E SUITE 208
CHARLESTON WV
25301-1864
US

IV. Provider business mailing address

1220 LEE STREET, E SUITE 208
CHARLESTON WV
25301
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-7270
  • Fax: 304-388-7280
Mailing address:
  • Phone: 304-388-7270
  • Fax: 304-388-7280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number114148
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: