Provider Demographics
NPI:1649735234
Name:HEAD, KAYLEIGH PAIGE (FNP)
Entity Type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:PAIGE
Last Name:HEAD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KAYLEIGH
Other - Middle Name:
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:2410 ROUND ROCK AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2410 ROUND ROCK AVE STE 250
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78681-4003
Practice Address - Country:US
Practice Address - Phone:512-341-8724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP1031107363LF0000X, 363LF0000X
LA203671363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily