Provider Demographics
NPI:1114567427
Name:NOVOA, KAYLA (PA)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:NOVOA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2559 MEDICAL DR STE 3100
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-8703
Mailing Address - Country:US
Mailing Address - Phone:575-446-5700
Mailing Address - Fax:888-987-7176
Practice Address - Street 1:2559 MEDICAL DR STE 3100
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-8703
Practice Address - Country:US
Practice Address - Phone:575-446-5700
Practice Address - Fax:888-987-7176
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-14
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2022-0073363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical