Provider Demographics
NPI:1992471387
Name:PRINCE, KAYLIE
Entity type:Individual
Prefix:
First Name:KAYLIE
Middle Name:
Last Name:PRINCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2068 ENERGY DR BLDG 3
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-8722
Mailing Address - Country:US
Mailing Address - Phone:984-345-2660
Mailing Address - Fax:
Practice Address - Street 1:2068 ENERGY DR BLDG 3
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-8722
Practice Address - Country:US
Practice Address - Phone:984-345-2660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty