MEDICARE: KAYLA BROAD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	SP033138	PA

General Provider Information

NPI Number	:	1053264499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA BROAD

Provider Business Mailing Address
First Line	:	231 HALLSTON RD
Second Line	:
City	:	SLIPPERY ROCK
State	:	PA
Zip	:	16057-5017
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 LOTHROP ST
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15213-2536
Country	:	US
Telephone Number	:	412-647-2345
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2026
Last Update Date	:	02/17/2026

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Directions to “ KAYLA BROAD ” Practice Location

Language	Start Address	Practice Location

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