Provider Demographics
NPI:1013549716
Name:CREEKMUR, KAYLA BROOKE (APRN)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:BROOKE
Last Name:CREEKMUR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 OAK ST
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-2873
Mailing Address - Country:US
Mailing Address - Phone:270-871-4124
Mailing Address - Fax:
Practice Address - Street 1:2955 FORT CAMPBELL BLVD
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-4901
Practice Address - Country:US
Practice Address - Phone:270-632-1548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014115363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner