MEDICARE: MRS. KATHRYN LAY 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	363LP2300X	Primary Care Nurse Practitioner	11020211	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578293908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHRYN LAY APRN

Provider Business Mailing Address
First Line	:	925 S ORANGE AVE
Second Line	:
City	:	BARTOW
State	:	FL
Zip	:	33830-5728
Country	:	US
Telephone Number	:	863-450-9321
Fax Number	:

Provider Business Practice Location Address
First Line	:	141 E CENTRAL AVE
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33880-6338
Country	:	US
Telephone Number	:	863-272-6536
Fax Number	:

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

Provider Enumeration Date	:	06/17/2022
Last Update Date	:	02/22/2024

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