Provider Demographics
NPI:1427740505
Name:ESTENES, KAYLAN MARTIN (NP)
Entity type:Individual
Prefix:
First Name:KAYLAN
Middle Name:MARTIN
Last Name:ESTENES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:KAYLAN
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:375 HOPE POND WAY UNIT 104
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-3439
Mailing Address - Country:US
Mailing Address - Phone:843-707-0006
Mailing Address - Fax:
Practice Address - Street 1:375 HOPE POND WAY UNIT 104
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-3439
Practice Address - Country:US
Practice Address - Phone:843-707-0006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN.30457363LF0000X
GANP248019363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner