MEDICARE: KAILEY JO MCKENNA APRN, PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11031498	FL

General Provider Information

NPI Number	:	1396505434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAILEY JO MCKENNA APRN, PMHNP

Provider Business Mailing Address
First Line	:	320 HOLLENBERG RD
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33875-6718
Country	:	US
Telephone Number	:	863-605-4521
Fax Number	:

Provider Business Practice Location Address
First Line	:	931 MALL RING RD
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-8515
Country	:	US
Telephone Number	:	863-312-8523
Fax Number	:	863-456-1327

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

Provider Enumeration Date	:	03/19/2024
Last Update Date	:	12/05/2025

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