Provider Demographics
NPI:1730686015
Name:ZIMMERMAN, KAYLA (APN, CNP)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:APN, CNP
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:SASSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:10 SAINT CLARE CT STE 100
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-9239
Mailing Address - Country:US
Mailing Address - Phone:309-886-4000
Mailing Address - Fax:309-886-4101
Practice Address - Street 1:10 SAINT CLARE CT STE 100
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-9239
Practice Address - Country:US
Practice Address - Phone:309-886-4000
Practice Address - Fax:309-886-4101
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041412855363L00000X
IL209017497363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner