Provider Demographics
NPI:1861902025
Name:MCCARTHY, KAYLA J (ANP)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:J
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:J
Other - Last Name:VONDERHAAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 419059
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-9059
Mailing Address - Country:US
Mailing Address - Phone:618-207-6900
Mailing Address - Fax:618-207-6901
Practice Address - Street 1:1167 FORTUNE BLVD
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62269
Practice Address - Country:US
Practice Address - Phone:618-207-6900
Practice Address - Fax:618-207-6901
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016819363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health