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General NPI Number Information
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NPI Number | 1821859810
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Entity Type | Individual
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Provider Name | KAYLA EVAN KRIESEL APRN
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Gender | Female
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Dates
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Enumeration Date | 01/17/2024
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 2500 W MAIN ST
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-2533
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Country | US
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Telephone | 479-219-9913
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Fax | 479-219-9914
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Provider Business Mailing Address
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Address Line | 1507 LANDS END PT S
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City | RUSSELLVILLE
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State | AR
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Zip | 72802-8800
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Country | US
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Telephone | 479-857-3178
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 227096
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License Number State | AR
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