Provider Demographics
NPI:1336883081
Name:CORBETT, KAYLA BOLEY (DO, MS)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:BOLEY
Last Name:CORBETT
Suffix:
Gender:F
Credentials:DO, MS
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:NICOLE
Other - Last Name:BOLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1215 LEE STREET BOX #800386
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22908-0816
Mailing Address - Country:US
Mailing Address - Phone:434-924-5429
Mailing Address - Fax:434-924-2816
Practice Address - Street 1:1215 LEE STREET BOX #800386
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-0816
Practice Address - Country:US
Practice Address - Phone:434-924-5429
Practice Address - Fax:434-924-2816
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X
VA0116040349390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program