Provider Demographics
NPI:1811548456
Name:BROUGHTON, KALYN DANIEL (CNA)
Entity Type:Individual
Prefix:MISS
First Name:KALYN
Middle Name:DANIEL
Last Name:BROUGHTON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5206 BROOKSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-8093
Mailing Address - Country:US
Mailing Address - Phone:843-668-0310
Mailing Address - Fax:
Practice Address - Street 1:5206 BROOKSTONE WAY
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-8093
Practice Address - Country:US
Practice Address - Phone:843-668-0310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide