Provider Demographics
NPI:1598107666
Name:WAHL, KAYCE A (NP)
Entity Type:Individual
Prefix:
First Name:KAYCE
Middle Name:A
Last Name:WAHL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KAYCE
Other - Middle Name:A
Other - Last Name:WENDEROTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36 PEMBERTON CV
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-5514
Mailing Address - Country:US
Mailing Address - Phone:731-394-1145
Mailing Address - Fax:
Practice Address - Street 1:509 N CARRIER ST
Practice Address - Street 2:
Practice Address - City:MORGANFIELD
Practice Address - State:KY
Practice Address - Zip Code:42437-1201
Practice Address - Country:US
Practice Address - Phone:731-394-1145
Practice Address - Fax:812-477-7240
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004552A363L00000X, 208VP0014X
KY3010114363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine