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General NPI Number Information
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NPI Number | 1215792874
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Entity Type | Individual
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Provider Name | KAYLA LEIGH NICHOLSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/13/2024
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 2500 N STATE ST
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City | JACKSON
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State | MS
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Zip | 39216-4500
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Country | US
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Telephone | 601-984-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 5201 LAKELAND BLVD APT 9
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City | FLOWOOD
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State | MS
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Zip | 39232-0010
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Country | US
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Telephone | 662-224-4296
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 00775
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License Number State | MS
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