Provider Demographics
NPI:1558994954
Name:RHOADES, KAYLEN RENEE (NP)
Entity Type:Individual
Prefix:MRS
First Name:KAYLEN
Middle Name:RENEE
Last Name:RHOADES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:KAYLEN
Other - Middle Name:RENEE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2156 HIGHWAY 52 E STE 150
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-6021
Mailing Address - Country:US
Mailing Address - Phone:205-920-1211
Mailing Address - Fax:205-920-2573
Practice Address - Street 1:2156 HIGHWAY 52 E STE 150
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-6021
Practice Address - Country:US
Practice Address - Phone:205-920-1211
Practice Address - Fax:205-920-2573
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-13
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-145608163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse