MEDICARE: TKAYLA KELLEY

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	106S00000X	Behavior Technician	RBT-24-355634	GA

General Provider Information

NPI Number	:	1396635983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TKAYLA KELLEY

Provider Business Mailing Address
First Line	:	65 IRBY AVE NW UNIT 1149
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-3345
Country	:	US
Telephone Number	:	404-759-9077
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 IRBY AVE NW UNIT 1149
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-3345
Country	:	US
Telephone Number	:	404-759-9077
Fax Number	:

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

Provider Enumeration Date	:	07/07/2025
Last Update Date	:	08/02/2025

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Directions to “ TKAYLA KELLEY ” Practice Location

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