Healthcare Provider Details

I. General information

NPI: 1023749140
Provider Name (Legal Business Name): KAYLA DAVIS APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 06/20/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 AMERICAN AVE
WAUKESHA WI
53188-5031
US

IV. Provider business mailing address

W275N317 ARROWHEAD TRL
WAUKESHA WI
53188-1915
US

V. Phone/Fax

Practice location:
  • Phone: 262-928-1000
  • Fax:
Mailing address:
  • Phone: 262-565-7569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number11986
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: