Provider Demographics
NPI:1639558299
Name:TODD, KAYLEIGH (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:
Last Name:TODD
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 BURLESON RD
Mailing Address - Street 2:APT 316
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-5609
Mailing Address - Country:US
Mailing Address - Phone:540-842-4472
Mailing Address - Fax:
Practice Address - Street 1:2500 BURLESON RD
Practice Address - Street 2:APT 316
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-5609
Practice Address - Country:US
Practice Address - Phone:540-842-4472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA838455363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics