Provider Demographics
NPI:1063265130
Name:TUCKER, KAYLA MICHELE (MNS, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:MICHELE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MNS, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 BLACKWELL DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35504-8406
Mailing Address - Country:US
Mailing Address - Phone:205-544-9612
Mailing Address - Fax:
Practice Address - Street 1:304 BLACKWELL DAIRY RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35504-8406
Practice Address - Country:US
Practice Address - Phone:205-544-9612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-155331363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty