Healthcare Provider Details

I. General information

NPI: 1144796764
Provider Name (Legal Business Name): KAYLA C TOURVILLE ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 09/29/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MEDICAL PLZ STE 150
LAKE ST LOUIS MO
63367-1483
US

IV. Provider business mailing address

3550 MCKELVEY RD
BRIDGETON MO
63044-2527
US

V. Phone/Fax

Practice location:
  • Phone: 636-625-2662
  • Fax:
Mailing address:
  • Phone: 314-741-0911
  • Fax: 314-741-0501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2018037134
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209020631
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2018037134
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2019040757
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209020631
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: