Provider Demographics
NPI:1578082137
Name:MOORE, KAYLA ANGLIN (NP-C)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:ANGLIN
Last Name:MOORE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 HIGHWAY 9 S
Mailing Address - Street 2:
Mailing Address - City:CALHOUN CITY
Mailing Address - State:MS
Mailing Address - Zip Code:38916-8900
Mailing Address - Country:US
Mailing Address - Phone:662-542-1477
Mailing Address - Fax:
Practice Address - Street 1:4381 S EASON BLVD STE 202
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6585
Practice Address - Country:US
Practice Address - Phone:662-377-6610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902287207QG0300X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine