Provider Demographics
NPI:1093447518
Name:WINDHAM, KAYLA MARIE (DNP, APRN, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:MARIE
Last Name:WINDHAM
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2293 PORTSIDE WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-9657
Mailing Address - Country:US
Mailing Address - Phone:843-696-7987
Mailing Address - Fax:
Practice Address - Street 1:570 LONG POINT RD STE 130
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7931
Practice Address - Country:US
Practice Address - Phone:843-884-2133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26249363L00000X
SC231182163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse