Provider Demographics
NPI:1003423997
Name:ABERNATHY, KAYLA NIKKOLE
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:NIKKOLE
Last Name:ABERNATHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WV
Mailing Address - Zip Code:25130-1505
Mailing Address - Country:US
Mailing Address - Phone:304-239-4583
Mailing Address - Fax:
Practice Address - Street 1:828 LEE AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WV
Practice Address - Zip Code:25130-1505
Practice Address - Country:US
Practice Address - Phone:304-239-4583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant