MEDICARE: KAYLA ROUTH

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	AP132784	TX

General Provider Information

NPI Number	:	1952845190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA ROUTH

Provider Business Mailing Address
First Line	:	PO BOX 937
Second Line	:
City	:	GOLDTHWAITE
State	:	TX
Zip	:	76844-0937
Country	:	US
Telephone Number	:	325-648-2850
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 W FRONT ST
Second Line	:
City	:	GOLDTHWAITE
State	:	TX
Zip	:	76844-2056
Country	:	US
Telephone Number	:	325-648-2850
Fax Number	:

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

Provider Enumeration Date	:	12/07/2016
Last Update Date	:	03/04/2025

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Directions to “ KAYLA ROUTH ” Practice Location

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