Provider Demographics
NPI:1376051292
Name:DETERS, KAYLA R (APN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:R
Last Name:DETERS
Suffix:
Gender:F
Credentials:APN, FNP-BC
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:R
Other - Last Name:FOOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1005 HEALTH CENTER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-4653
Mailing Address - Country:US
Mailing Address - Phone:217-868-2812
Mailing Address - Fax:
Practice Address - Street 1:1303 W EVERGREEN AVE STE 200
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-1638
Practice Address - Country:US
Practice Address - Phone:217-342-3400
Practice Address - Fax:217-342-6417
Is Sole Proprietor?:No
Enumeration Date:2018-01-12
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016977363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner