Provider Demographics
NPI:1407676984
Name:ELY, KAYLA M (RN)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:M
Last Name:ELY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:M
Other - Last Name:ALARID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:209 E WOODMAN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:IL
Mailing Address - Zip Code:60541-9384
Mailing Address - Country:US
Mailing Address - Phone:815-414-1991
Mailing Address - Fax:
Practice Address - Street 1:1168 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1589
Practice Address - Country:US
Practice Address - Phone:815-690-5337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.460671163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse