=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932992427
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAYLA POTTER DNP, FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2025
-----------------------------------------------------
Last Update Date | 08/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 MORGAN FARMS DR
-----------------------------------------------------
City | SOUTH WINDSOR
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06074-1391
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-644-5458
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29 HORSESHOE LN
-----------------------------------------------------
City | SOMERS
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06071-2235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 14288
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------