Provider Demographics
NPI:1104492867
Name:GEISER, KAYLEIGH (FNP-C)
Entity type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:
Last Name:GEISER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:OH
Mailing Address - Zip Code:45311-1007
Mailing Address - Country:US
Mailing Address - Phone:937-452-1202
Mailing Address - Fax:
Practice Address - Street 1:10058 COOLEY RD
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47012-9509
Practice Address - Country:US
Practice Address - Phone:765-647-3557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0028996207Q00000X, 363LF0000X
IN71012566A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty