Provider Demographics
NPI:1629722293
Name:HOWARD, KAYLOR L (FNP)
Entity Type:Individual
Prefix:
First Name:KAYLOR
Middle Name:L
Last Name:HOWARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 DEEP WOOD DR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-7447
Mailing Address - Country:US
Mailing Address - Phone:470-572-3199
Mailing Address - Fax:800-504-1362
Practice Address - Street 1:2313 DEEP WOOD DR
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-7447
Practice Address - Country:US
Practice Address - Phone:470-572-3199
Practice Address - Fax:800-504-1362
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-11
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN288647363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily