Provider Demographics
NPI:1710692504
Name:FAILS, KAYLEIGH BREANE (RN)
Entity Type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:BREANE
Last Name:FAILS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 W NINE MILE RD UNIT 5102
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32534-5363
Mailing Address - Country:US
Mailing Address - Phone:850-384-1774
Mailing Address - Fax:
Practice Address - Street 1:1431 W NINE MILE RD UNIT 5102
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32534-5363
Practice Address - Country:US
Practice Address - Phone:850-384-1774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9505025163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse