MEDICARE: KAYLA RENAE COMBS NP-C

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	363LF0000X	Family Nurse Practitioner	F01190299	KY

General Provider Information

NPI Number	:	1124684212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA RENAE COMBS NP-C

Provider Business Mailing Address
First Line	:	449 PINE RIDGE LN
Second Line	:
City	:	HARDINSBURG
State	:	KY
Zip	:	40143-6647
Country	:	US
Telephone Number	:	502-649-6219
Fax Number	:

Provider Business Practice Location Address
First Line	:	3832 TAYLORSVILLE RD UNIT 8-10
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40220-1369
Country	:	US
Telephone Number	:	502-649-6219
Fax Number	:

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

Provider Enumeration Date	:	05/14/2019
Last Update Date	:	02/09/2022

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