Basic Information
Provider Information | |||||||||
NPI: | 1972072593 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LAYMAN | ||||||||
FirstName: | KAITLYN | ||||||||
MiddleName: | MARGARET | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DNP, FNP-BC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MALLON | ||||||||
OtherFirstName: | KAITLYN | ||||||||
OtherMiddleName: | MARGARET | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2105 TERRY AVE | ||||||||
Address2: |   | ||||||||
City: | MELISSA | ||||||||
State: | TX | ||||||||
PostalCode: | 754540770 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5404944098 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 5655 W SPRING CREEK PKWY | ||||||||
Address2: | SUITE 200 | ||||||||
City: | PLANO | ||||||||
State: | TX | ||||||||
PostalCode: | 75024 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2144732200 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/14/2018 | ||||||||
LastUpdateDate: | 07/18/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/07/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP139604 | TX | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.