Basic Information
| Provider Information | |||||||||
| NPI: | 1619503463 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAGGETT | ||||||||
| FirstName: | KAYLA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1229 ETHRIDGE LN | ||||||||
| Address2: | |||||||||
| City: | UNION CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 382615822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7314461270 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1201 BISHOP ST | ||||||||
| Address2: | |||||||||
| City: | UNION CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 382615403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7318852410 | ||||||||
| FaxNumber: | 7318848692 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2020 | ||||||||
| LastUpdateDate: | 03/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 363L00000X | 27387 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.