Provider Demographics
NPI:1396580643
Name:STAFFORD, KAYLA JUSTINE (FNP-C)
Entity type:Individual
Prefix:MISS
First Name:KAYLA
Middle Name:JUSTINE
Last Name:STAFFORD
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 1:388 4TH ST NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2005
Mailing Address - Country:US
Mailing Address - Phone:317-600-8717
Mailing Address - Fax:
Practice Address - Street 1:3422 SIXES RD STE 102
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-9120
Practice Address - Country:US
Practice Address - Phone:943-202-7670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN267058363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily