MEDICARE: KAYLA BROOKE ENSIGN

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1053269894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA BROOKE ENSIGN

Provider Business Mailing Address
First Line	:	399 COLLINS DR
Second Line	:
City	:	ELIZABETHTOWN
State	:	KY
Zip	:	42701-8109
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3430 NEWBURG RD STE 150
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-2497
Country	:	US
Telephone Number	:	502-636-7111
Fax Number	:

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

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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Directions to “ KAYLA BROOKE ENSIGN ” Practice Location

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