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General NPI Number Information
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NPI Number | 1801651310
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Entity Type | Individual
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Provider Name | KAYLA B KINNEBREW PMHNP
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Gender | Female
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Dates
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Enumeration Date | 02/14/2024
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 442 DELAWARE ST
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City | SHREVEPORT
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State | LA
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Zip | 71106-1634
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Country | US
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Telephone | 318-730-8060
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Fax |
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Provider Business Mailing Address
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Address Line | 670 ALBEMARLE DR BLDG 7
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City | SHREVEPORT
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State | LA
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Zip | 71106-5945
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Country | US
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Telephone | 318-562-6903
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 242633
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN144989
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License Number State | LA
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