Provider Demographics
NPI:1023544913
Name:MCHALE, KAYLA R
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:R
Last Name:MCHALE
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 1:3291B HARRY DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:BULLOCK
Mailing Address - State:NC
Mailing Address - Zip Code:27507-9594
Mailing Address - Country:US
Mailing Address - Phone:717-578-1241
Mailing Address - Fax:
Practice Address - Street 1:414 DABNEY DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-3944
Practice Address - Country:US
Practice Address - Phone:252-430-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X, 390200000X
NC5259111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program