Provider Demographics
NPI:1124728555
Name:MATTEO, KAYLA LEE (APN)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:LEE
Last Name:MATTEO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 W MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL SPRINGS
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-3121
Mailing Address - Country:US
Mailing Address - Phone:609-413-3630
Mailing Address - Fax:
Practice Address - Street 1:311 COMMONS WAY
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1510
Practice Address - Country:US
Practice Address - Phone:609-921-7747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ14966600363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner