Provider Demographics
NPI:1225522758
Name:FREEMAN, KYLA RAE (MD)
Entity Type:Individual
Prefix:DR
First Name:KYLA
Middle Name:RAE
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KYLA
Other - Middle Name:RAE
Other - Last Name:WILKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:325 HAWTHORNE LN STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2536
Practice Address - Country:US
Practice Address - Phone:704-973-2106
Practice Address - Fax:704-973-2395
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL52419207V00000X
NC2022-02374207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology