Provider Demographics
NPI:1114693108
Name:SPEARS, KAYLA (NP)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:SPEARS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:6923 W 400 N
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-9198
Mailing Address - Country:US
Mailing Address - Phone:219-325-0604
Mailing Address - Fax:219-879-1401
Practice Address - Street 1:6923 W 400 N
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-9198
Practice Address - Country:US
Practice Address - Phone:219-325-0604
Practice Address - Fax:219-879-1401
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28223724A363L00000X
IN71011782A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner