Provider Demographics
NPI:1831065655
Name:TILLEY, KAYLA MICHELLE
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MICHELLE
Last Name:TILLEY
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:PO BOX 53
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:WV
Mailing Address - Zip Code:24898-0053
Mailing Address - Country:US
Mailing Address - Phone:304-573-1004
Mailing Address - Fax:
Practice Address - Street 1:4368 R D BAILEY HWY
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:WV
Practice Address - Zip Code:24898-1107
Practice Address - Country:US
Practice Address - Phone:304-573-1004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-17
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant