Provider Demographics
NPI:1871192070
Name:TWITTY-KISER, LAYATA SHAUNDRIA (LPN- LICENSED NURSE)
Entity Type:Individual
Prefix:MS
First Name:LAYATA
Middle Name:SHAUNDRIA
Last Name:TWITTY-KISER
Suffix:
Gender:F
Credentials:LPN- LICENSED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 SPRING FOREST ROAD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301
Mailing Address - Country:US
Mailing Address - Phone:850-688-4280
Mailing Address - Fax:
Practice Address - Street 1:2521 SPRING FOREST ROAD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301
Practice Address - Country:US
Practice Address - Phone:850-688-4280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN-1346811164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse