MEDICARE: KAYLA NEVILL APRN, CPNP-PC

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	363LP0200X	Pediatric Nurse Practitioner	1112065	TX

General Provider Information

NPI Number	:	1932808664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA NEVILL APRN, CPNP-PC

Provider Business Mailing Address
First Line	:	230 T C JESTER BLVD APT 320
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-3279
Country	:	US
Telephone Number	:	713-492-8304
Fax Number	:

Provider Business Practice Location Address
First Line	:	1740 W 27TH ST STE 305
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1437
Country	:	US
Telephone Number	:	713-861-4800
Fax Number	:	713-861-7762

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

Provider Enumeration Date	:	03/02/2023
Last Update Date	:	03/02/2023

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