MEDICARE: KAYLA ST AMOUR

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	363LG0600X	Gerontology Nurse Practitioner	7510	CT

General Provider Information

NPI Number	:	1205330610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA ST AMOUR

Provider Business Mailing Address
First Line	:	35 TIFT ST
Second Line	:
City	:	JEWETT CITY
State	:	CT
Zip	:	06351-1821
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	86 NEW LONDON TPKE
Second Line	:
City	:	NORWICH
State	:	CT
Zip	:	06360-2616
Country	:	US
Telephone Number	:	860-889-6967
Fax Number	:

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

Provider Enumeration Date	:	03/20/2018
Last Update Date	:	03/20/2018

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Directions to “ KAYLA ST AMOUR ” Practice Location

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