Healthcare Provider Details

I. General information

NPI: 1538438635
Provider Name (Legal Business Name): KYLA HEUSNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2011
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2812 54TH AVE S
SAINT PETERSBURG FL
33712-4610
US

IV. Provider business mailing address

2812 54TH AVE S
SAINT PETERSBURG FL
33712-4610
US

V. Phone/Fax

Practice location:
  • Phone: 727-867-8641
  • Fax: 727-867-6795
Mailing address:
  • Phone: 727-867-8641
  • Fax: 727-867-6795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME121651
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: