Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0200X | Nurse Practitioner - Pediatrics | 0024176493 | VA |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 5011512 | NC |
NPI | 1003395948 |
---|---|
Provider Name | Kaila Haskins |
First Address | Bassett, VA 24055-6108 |
Second Address | Greensboro, NC 27401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2018 |
Last Update Date | 01/07/2019 |