Provider Demographics
NPI:1073022539
Name:CARLSON, KAYLA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 MCNEEL LN
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-6054
Mailing Address - Country:US
Mailing Address - Phone:308-534-6655
Mailing Address - Fax:
Practice Address - Street 1:215 MCNEEL LN
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6054
Practice Address - Country:US
Practice Address - Phone:308-534-6655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2165207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery