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General NPI Number Information
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NPI Number | 1225965460
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Entity Type | Organization
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Legal Business Name | KIYLA MENTAL CLINIC LLC
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Dates
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Enumeration Date | 05/04/2026
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Last Update Date | 05/04/2026
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Provider Practice Location Address
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Address Line | 2387 PROFESSIONAL HEIGHTS DR STE 140
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City | LEXINGTON
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State | KY
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Zip | 40503-3056
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Country | US
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Telephone | 859-303-5794
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Fax | 859-303-5390
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Provider Business Mailing Address
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Address Line | 617 HAVANA CT
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City | LEXINGTON
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State | KY
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Zip | 40511-8852
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Country | US
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Telephone | 859-303-5794
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Fax | 859-303-5390
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Authorized Official
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Title or Position | ED
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Name | MR. NICHOLAS BRADY STARK
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Credential |
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Telephone | 812-801-1352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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