Provider Demographics
NPI:1649872714
Name:HALL, KAYLA (NP-C)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2144 EMERALD LN
Mailing Address - Street 2:
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-1430
Mailing Address - Country:US
Mailing Address - Phone:586-322-7624
Mailing Address - Fax:
Practice Address - Street 1:3901 BEAUBIEN ST FL 1
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2119
Practice Address - Country:US
Practice Address - Phone:313-832-8290
Practice Address - Fax:313-993-0081
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704293889363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner