Healthcare Provider Details

I. General information

NPI: 1265902076
Provider Name (Legal Business Name): KAYLA MARIE WATKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2018
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8625 COLLEGE BLVD STE 103
OVERLAND PARK KS
66210-2192
US

IV. Provider business mailing address

12900 W 133RD PL APT 9106
OVERLAND PARK KS
66213-4956
US

V. Phone/Fax

Practice location:
  • Phone: 913-777-0077
  • Fax:
Mailing address:
  • Phone: 918-605-9159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2018011105
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5378108101
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: