Provider Demographics
NPI:1760958169
Name:WALKER, KAYLA WANDRICK (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:WANDRICK
Last Name:WALKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:KAYLA
Other - Middle Name:NICOLE
Other - Last Name:WANDRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2747 RAMSGATE CT NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2817
Mailing Address - Country:US
Mailing Address - Phone:704-038-2337
Mailing Address - Fax:
Practice Address - Street 1:2747 RAMSGATE CT NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2817
Practice Address - Country:US
Practice Address - Phone:770-403-8233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTEMPORARY363A00000X
TXPA12402363A00000X
GA12007363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant