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General NPI Number Information
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NPI Number | 1750189437
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Entity Type | Individual
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Provider Name | KAYLA LANDAVERDE
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Gender | Female
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Dates
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Enumeration Date | 03/06/2025
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 433 HIGHLAND PKWY STE 201
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City | ELLIJAY
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State | GA
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Zip | 30540-7658
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Country | US
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Telephone | 678-513-2273
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Fax | 678-513-8869
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Provider Business Mailing Address
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Address Line | 3970 DEP BILL CANTRELL MEMORIAL RD
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City | CUMMING
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State | GA
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Zip | 30040-3011
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Country | US
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Telephone | 678-513-2273
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Fax | 678-513-8869
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN296397
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License Number State | GA
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