Provider Demographics
NPI:1093596215
Name:WALTERS, KAYLA (LPN)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3080 SAINT ROSE PKWY UNIT 1209
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3548
Mailing Address - Country:US
Mailing Address - Phone:347-571-7110
Mailing Address - Fax:
Practice Address - Street 1:2887 S MARYLAND PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-1511
Practice Address - Country:US
Practice Address - Phone:702-474-4104
Practice Address - Fax:702-474-4108
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP07315100164W00000X
NV867881164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse