Provider Demographics
NPI:1104551290
Name:STATON, KALYN (ND, MIP)
Entity type:Individual
Prefix:
First Name:KALYN
Middle Name:
Last Name:STATON
Suffix:
Gender:F
Credentials:ND, MIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 HARTMAN RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-9223
Mailing Address - Country:US
Mailing Address - Phone:336-602-3545
Mailing Address - Fax:
Practice Address - Street 1:593 HARTMAN RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-9223
Practice Address - Country:US
Practice Address - Phone:336-602-3545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath