Healthcare Provider Details

I. General information

NPI: 1396505434
Provider Name (Legal Business Name): KAILEY JO MCKENNA APRN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 MALL RING RD
SEBRING FL
33870-8515
US

IV. Provider business mailing address

320 HOLLENBERG RD
SEBRING FL
33875-6718
US

V. Phone/Fax

Practice location:
  • Phone: 863-312-8523
  • Fax: 863-456-1327
Mailing address:
  • Phone: 863-605-4521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11031498
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: