Provider Demographics
NPI:1932965357
Name:WATERS, KAYLEE ANNE
Entity type:Individual
Prefix:MRS
First Name:KAYLEE
Middle Name:ANNE
Last Name:WATERS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KAYLEE
Other - Middle Name:ANNE
Other - Last Name:HOLLENBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1122 MYRTLE ST APT 7
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1168
Mailing Address - Country:US
Mailing Address - Phone:717-571-4539
Mailing Address - Fax:
Practice Address - Street 1:3 W OLIVE ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-2572
Practice Address - Country:US
Practice Address - Phone:570-808-7916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN743981163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory