Provider Demographics
NPI:1033746755
Name:MADISON, KAYLA (DNP-FNP)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:MADISON
Suffix:
Gender:F
Credentials:DNP-FNP
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:BOWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:600 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61362-1512
Mailing Address - Country:US
Mailing Address - Phone:815-664-2617
Mailing Address - Fax:815-663-0103
Practice Address - Street 1:600 E 1ST ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61362-1512
Practice Address - Country:US
Practice Address - Phone:815-664-5367
Practice Address - Fax:815-664-5204
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.392961363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner