Provider Demographics
NPI:1255102760
Name:WEBBER, KAYLEIGH NICKOL
Entity type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:NICKOL
Last Name:WEBBER
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 1:5329 HUNT MASTER DR APT D
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2754
Mailing Address - Country:US
Mailing Address - Phone:804-517-7195
Mailing Address - Fax:
Practice Address - Street 1:5329 HUNT MASTER DR APT D
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2754
Practice Address - Country:US
Practice Address - Phone:804-517-7195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program