Healthcare Provider Details

I. General information

NPI: 1134698160
Provider Name (Legal Business Name): KAYLA ROSE PERCY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 N F AVE
DOUGLAS AZ
85607-1920
US

IV. Provider business mailing address

235 S CASTLE ST
BALTIMORE MD
21231-2602
US

V. Phone/Fax

Practice location:
  • Phone: 520-364-1429
  • Fax:
Mailing address:
  • Phone: 512-826-3095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR223872
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: