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General NPI Number Information
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NPI Number | 1346910957
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Entity Type | Individual
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Provider Name | KYLA HENNIGAN CNM, WHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/15/2021
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 1000 E MOUNTAIN BLVD
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City | WILKES BARRE
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State | PA
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Zip | 18711-0027
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Country | US
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Telephone | 570-808-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 134 DORAN DR
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City | SHAVERTOWN
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State | PA
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Zip | 18708-1613
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Country | US
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Telephone | 570-899-5749
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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 | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | MW010823
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | SP030763
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License Number State | PA
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