Basic Information
| Provider Information | |||||||||
| NPI: | 1639201866 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAYYE | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | GAY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1633 MASSENGILL POND RD | ||||||||
| Address2: | |||||||||
| City: | ANGIER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275019398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196396229 | ||||||||
| FaxNumber: | 9196399058 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285466333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103535118 | ||||||||
| FaxNumber: | 9105771338 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | MK0139964 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | MK0139964 | 01 | NC | DEA NUMBER | OTHER |