Provider Demographics
NPI:1891524542
Name:FALLIS, KAYLA NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:NICOLE
Last Name:FALLIS
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 PINE ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-4916
Mailing Address - Country:US
Mailing Address - Phone:603-670-4567
Mailing Address - Fax:
Practice Address - Street 1:565 AMHERST ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-1048
Practice Address - Country:US
Practice Address - Phone:603-578-3347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2964363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant