Provider Demographics
NPI:1982217444
Name:NICHOLAS, KAYLA DAWN
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:DAWN
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 BARKER LN
Mailing Address - Street 2:
Mailing Address - City:LETART
Mailing Address - State:WV
Mailing Address - Zip Code:25253-1104
Mailing Address - Country:US
Mailing Address - Phone:304-674-7649
Mailing Address - Fax:
Practice Address - Street 1:52 BARKER LN
Practice Address - Street 2:
Practice Address - City:LETART
Practice Address - State:WV
Practice Address - Zip Code:25253-1104
Practice Address - Country:US
Practice Address - Phone:304-674-7649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant