Provider Demographics
NPI:1548053630
Name:LONGINO, KAYLA BROOKE (FNP-C)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:BROOKE
Last Name:LONGINO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 GIORGIO MORODER DR
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-2555
Mailing Address - Country:US
Mailing Address - Phone:512-413-9559
Mailing Address - Fax:
Practice Address - Street 1:711 W 10TH ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:TX
Practice Address - Zip Code:78621-2261
Practice Address - Country:US
Practice Address - Phone:512-229-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1193437363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily