Provider Demographics
NPI:1093576753
Name:DEVALL, KAYLIE (FNP)
Entity Type:Individual
Prefix:
First Name:KAYLIE
Middle Name:
Last Name:DEVALL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10130 CROSSING WAY STE 335
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-5889
Mailing Address - Country:US
Mailing Address - Phone:225-667-2777
Mailing Address - Fax:
Practice Address - Street 1:10130 CROSSING WAY STE 335
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-5889
Practice Address - Country:US
Practice Address - Phone:225-667-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA234477363LF0000X
LARN156427163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily