Provider Demographics
NPI:1730782699
Name:BARGO, KAYLA LARAE (APRN)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:LARAE
Last Name:BARGO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:KAYLA
Other - Middle Name:LARAE
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:80 HOSPITAL DR STE 2
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-7363
Mailing Address - Country:US
Mailing Address - Phone:606-545-4460
Mailing Address - Fax:
Practice Address - Street 1:80 HOSPITAL DR STE 2
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-7363
Practice Address - Country:US
Practice Address - Phone:606-545-4460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015329363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily