Provider Demographics
NPI:1427740505
Name:ESTENES, KAYLAN MARTIN (NP)
Entity type:Individual
Prefix:
First Name:KAYLAN
Middle Name:MARTIN
Last Name:ESTENES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:KAYLAN
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4750 WATERS AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6267
Mailing Address - Country:US
Mailing Address - Phone:912-350-6543
Mailing Address - Fax:912-350-7690
Practice Address - Street 1:4750 WATERS AVE STE 108
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6267
Practice Address - Country:US
Practice Address - Phone:912-350-6543
Practice Address - Fax:912-350-7690
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN248019363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner