MEDICARE: KALYN BAYLY MACGIBBON CAA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367H00000X	Anesthesiologist Assistant	PENDING	FL
2	367H00000X	Anesthesiologist Assistant	AA978	FL

General Provider Information

NPI Number	:	1194557793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALYN BAYLY MACGIBBON CAA

Provider Business Mailing Address
First Line	:	141 SANTA MONICA AVE
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-1102
Country	:	US
Telephone Number	:	561-398-1652
Fax Number	:

Provider Business Practice Location Address
First Line	:	1525 W. CYPRESS CREEK RD
Second Line	:
City	:	FT. LAUDERDALE
State	:	FL
Zip	:	33309
Country	:	US
Telephone Number	:	954-939-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2024
Last Update Date	:	10/14/2024

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