Provider Demographics
NPI:1952924649
Name:NANCE, KAYLA JENAY (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:JENAY
Last Name:NANCE
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:J
Other - Last Name:KVISLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:249 WILLIAMSON RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8195
Mailing Address - Country:US
Mailing Address - Phone:704-746-9698
Mailing Address - Fax:
Practice Address - Street 1:245 LE PHILLIP CT NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2900
Practice Address - Country:US
Practice Address - Phone:704-746-9698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14067235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty