Provider Demographics
NPI:1093345415
Name:PRYOR, KAYLA ANN (APRN)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:ANN
Last Name:PRYOR
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 1:102 SOUTH WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:BARTELSO
Mailing Address - State:IL
Mailing Address - Zip Code:62218
Mailing Address - Country:US
Mailing Address - Phone:618-363-6597
Mailing Address - Fax:
Practice Address - Street 1:2001 STATE ST
Practice Address - Street 2:
Practice Address - City:EAST SAINT LOUIS
Practice Address - State:IL
Practice Address - Zip Code:62205-1803
Practice Address - Country:US
Practice Address - Phone:618-271-0204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020484363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily