Provider Demographics
NPI:1093257313
Name:SMALLING, KAYLA (FNP-C)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:SMALLING
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6119 US HIGHWAY 11
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-3991
Mailing Address - Country:US
Mailing Address - Phone:315-261-5810
Mailing Address - Fax:
Practice Address - Street 1:6119 US HIGHWAY 11
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-3991
Practice Address - Country:US
Practice Address - Phone:315-261-5810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY701890163WC0400X
390200000X
NY350187363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program