Healthcare Provider Details

I. General information

NPI: 1396349619
Provider Name (Legal Business Name): KAYLA STEELE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2020
Last Update Date: 11/27/2020
Certification Date: 11/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 W 9TH ST
RUSSELLVILLE KY
42276-9760
US

IV. Provider business mailing address

PO BOX 306244
NASHVILLE TN
37230-6244
US

V. Phone/Fax

Practice location:
  • Phone: 270-847-4033
  • Fax:
Mailing address:
  • Phone: 931-253-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3015002
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: