Provider Demographics
NPI:1043801525
Name:BISHTON, KAYLA MARIE (AUD, CCC-A)
Entity Type:Individual
Prefix:MISS
First Name:KAYLA
Middle Name:MARIE
Last Name:BISHTON
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7484 LEE DAVIS RD STE 10
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-3678
Mailing Address - Country:US
Mailing Address - Phone:804-789-1764
Mailing Address - Fax:804-789-1762
Practice Address - Street 1:7484 LEE DAVIS RD STE 10
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-3678
Practice Address - Country:US
Practice Address - Phone:804-789-1764
Practice Address - Fax:804-789-1762
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2102003078237600000X
VA2201001798231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter