Healthcare Provider Details

I. General information

NPI: 1821925991
Provider Name (Legal Business Name): MIKAYLA GRACE HARTLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 WHITESTICK ST
MABSCOTT WV
25871
US

IV. Provider business mailing address

240 LANIER DR
LEXINGTON NC
27295-1052
US

V. Phone/Fax

Practice location:
  • Phone: 304-254-8709
  • Fax:
Mailing address:
  • Phone: 304-575-3392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: