MEDICARE: KAYLA MICHELLE FRIDLEY APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN11041279	FL

General Provider Information

NPI Number	:	1386528669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA MICHELLE FRIDLEY APRN

Provider Business Mailing Address
First Line	:	338 NE SEEDLING LOOP
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-6726
Country	:	US
Telephone Number	:	863-447-5811
Fax Number	:	863-447-5811

Provider Business Practice Location Address
First Line	:	2218 W US HIGHWAY 90 STE 102
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-7281
Country	:	US
Telephone Number	:	386-243-8991
Fax Number	:	386-243-8997

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2025
Last Update Date	:	08/01/2025

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