Provider Demographics
NPI:1417520206
Name:PELFREY, KAYLA ALEXANDRIA (PMHNP)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:ALEXANDRIA
Last Name:PELFREY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 ROLLING MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-4083
Mailing Address - Country:US
Mailing Address - Phone:740-357-5343
Mailing Address - Fax:
Practice Address - Street 1:130 ROLLING MEADOWS DR
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-4083
Practice Address - Country:US
Practice Address - Phone:740-357-5343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2021037099363LP0808X
OH29687363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0464836Medicaid
OH0027719Medicaid