Provider Demographics
NPI:1730813015
Name:KELLAMS, KAYLA MARIE (MSN,FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:MARIE
Last Name:KELLAMS
Suffix:
Gender:F
Credentials:MSN,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:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:IN
Mailing Address - Zip Code:47838-0002
Mailing Address - Country:US
Mailing Address - Phone:812-691-2579
Mailing Address - Fax:
Practice Address - Street 1:6908 S OLD 41
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:IN
Practice Address - Zip Code:47838-8384
Practice Address - Country:US
Practice Address - Phone:812-398-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INF06221962363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily