Kayla Gentry Bullard, MSW, LCSWA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P016296 Issued in NC

Practice address

714 Carolina Ave Ste a
Yadkinville, NC 27055-7793

Phone

(336) 818-0733

NPI assigned

Jun 14, 2021

Last updated

Jan 20, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jodi Province Counseling Services PLLC

  • Mental Health Counselor
  • Wilkesboro, NC
  • NPI 1194050435
  NPD
• Jodi Province Counseling Services PLLC

  • Professional Counselor
  • Yadkinville, NC
  • NPI 1790249969
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642636800000",
    "number": "1255909594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 SYLVAN RD",
            "city": "THURMOND",
            "state": "NC",
            "postal_code": "286839439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 CAROLINA AVE STE A",
            "city": "YADKINVILLE",
            "state": "NC",
            "postal_code": "270557793",
            "telephone_number": "336-818-0733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLARD",
        "first_name": "KAYLA",
        "middle_name": "GENTRY",
        "credential": "MSW, LCSWA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-14",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P016296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mackenzie Lauren Boyles, LCMHCA
• Brenda & Associates (Added Touch Home Care)
• Brenda & Associates (Added Touch Home Care)
• Cynthia Brown Stiltner, NCC, LCAS-A, LCMHCA
• Hope Bryant
• Wanda J Burger, LPC
• Brooke Leigh Butler
• Jong Koo Byun, DDS
• Cah Acquisition Company 10 LLC (Yadkin Valley Community Hospital)
• Cah Acquisition Company 10 LLC (Yadkin Valley Community Hosptial Professional Staff)

• Clinical Social Worker in Yadkinville, NC
• Providers in Yadkinville, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.