Healthcare Provider Details

I. General information

NPI: 1770137580
Provider Name (Legal Business Name): KAYLA MICHELLE OTWORTH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 HAL GREER BLVD
HUNTINGTON WV
25701-3804
US

IV. Provider business mailing address

1340 HAL GREER BLVD
HUNTINGTON WV
25701-3804
US

V. Phone/Fax

Practice location:
  • Phone: 304-526-2200
  • Fax: 304-399-1507
Mailing address:
  • Phone: 304-526-2200
  • Fax: 304-399-1507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10028859
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number103703
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: