Provider Demographics
NPI:1891311999
Name:CORNELIUS, KAYLA ANN (FNP-BC)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:ANN
Last Name:CORNELIUS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4831 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-3681
Mailing Address - Country:US
Mailing Address - Phone:479-438-4678
Mailing Address - Fax:
Practice Address - Street 1:4831 N 11TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-3681
Practice Address - Country:US
Practice Address - Phone:602-424-2101
Practice Address - Fax:602-424-2103
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ248005363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily