Provider Demographics
NPI:1326811258
Name:MADDOX, KAYLA RENEE (FNP-C)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:RENEE
Last Name:MADDOX
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CROFT CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:TURTLETOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37391-4407
Mailing Address - Country:US
Mailing Address - Phone:423-241-2822
Mailing Address - Fax:
Practice Address - Street 1:144 MEDICAL CENTER DR STE B
Practice Address - Street 2:
Practice Address - City:COPPERHILL
Practice Address - State:TN
Practice Address - Zip Code:37317-5006
Practice Address - Country:US
Practice Address - Phone:423-496-9214
Practice Address - Fax:423-496-7809
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35115363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner