Provider Demographics
NPI:1245972868
Name:PROCTOR, KAILEY D (DO)
Entity type:Individual
Prefix:DR
First Name:KAILEY
Middle Name:D
Last Name:PROCTOR
Suffix:
Gender:
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:86 W UNDERWOOD ST STE 202
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1110
Mailing Address - Country:US
Mailing Address - Phone:321-841-8642
Mailing Address - Fax:407-872-0544
Practice Address - Street 1:5680 N TOWER RD STE 120
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80249-8024
Practice Address - Country:US
Practice Address - Phone:720-734-8816
Practice Address - Fax:720-405-4454
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-13
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CODR0074765208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program