Provider Demographics
NPI:1144796764
Name:TOURVILLE, KAYLA C (ACNP)
Entity Type:Individual
Prefix:MS
First Name:KAYLA
Middle Name:C
Last Name:TOURVILLE
Suffix:
Gender:F
Credentials:ACNP
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Mailing Address - Street 1:3550 MCKELVEY RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2527
Mailing Address - Country:US
Mailing Address - Phone:314-741-0911
Mailing Address - Fax:314-741-0501
Practice Address - Street 1:11155 DUNN RD STE 304E
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6111
Practice Address - Country:US
Practice Address - Phone:314-741-0911
Practice Address - Fax:314-741-0501
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209020631363LA2100X, 363LA2200X
MO2019040757363LA2200X
MO2018037134363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420061876Medicaid