Provider Demographics
NPI:1063206571
Name:WALDEN, KAYLA AMANDA SUDDETH (DC)
Entity type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:AMANDA SUDDETH
Last Name:WALDEN
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:AMANDA
Other - Last Name:SUDDETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 LOOKOUT POINT PL
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-2392
Mailing Address - Country:US
Mailing Address - Phone:704-659-6734
Mailing Address - Fax:
Practice Address - Street 1:444 WILLIAMSON RD STE C
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9248
Practice Address - Country:US
Practice Address - Phone:704-663-5142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5901111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor