Provider Demographics
NPI:1275230732
Name:NEWSTROM, KAYLA
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:NEWSTROM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:RASNAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:271 W 3RD ST N STE 600
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-1223
Mailing Address - Country:US
Mailing Address - Phone:316-660-7600
Mailing Address - Fax:
Practice Address - Street 1:3775 ROSWELL RD STE 150
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-8821
Practice Address - Country:US
Practice Address - Phone:770-274-4435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN306016363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily