Healthcare Provider Details

I. General information

NPI: 1982529723
Provider Name (Legal Business Name): KAYLA GRACE BRUSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 JENNY LIND RD
FORT SMITH AR
72901-7101
US

IV. Provider business mailing address

3300 RAMSGATE WAY
FORT SMITH AR
72908-9350
US

V. Phone/Fax

Practice location:
  • Phone: 479-785-2501
  • Fax:
Mailing address:
  • Phone: 479-785-2501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SS0200X
TaxonomySchool Clinical Nurse Specialist
License Number104732
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: