Provider Demographics
NPI:1831086313
Name:CARPENTER, KAYLA RENE' (RN, LMBT)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:RENE'
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:RN, LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3524 CONGRESS SQ
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-0223
Mailing Address - Country:US
Mailing Address - Phone:336-817-8429
Mailing Address - Fax:
Practice Address - Street 1:520 ARBOR HILL RD STE B
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-3346
Practice Address - Country:US
Practice Address - Phone:865-228-1182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22097225700000X
NC282940163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No163W00000XNursing Service ProvidersRegistered Nurse