=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336806876
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAYLA LEE DOLLY CPNP-PC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2021
-----------------------------------------------------
Last Update Date | 09/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 160 SHADY HILL LN
-----------------------------------------------------
City | WILEY FORD
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26767-8016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-709-2471
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 160 SHADY HILL LN
-----------------------------------------------------
City | WILEY FORD
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26767-8016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-624-6694
-----------------------------------------------------
Fax | 833-340-2409
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | AC007193
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | 108740
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | SP031560
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------