Provider Demographics
NPI:1407247281
Name:FURR, KAYLA ANN (AGPC-NP)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:ANN
Last Name:FURR
Suffix:
Gender:F
Credentials:AGPC-NP
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:ANN
Other - Last Name:SCALLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGPC-NP
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:774-443-3886
Practice Address - Fax:774-443-3913
Is Sole Proprietor?:No
Enumeration Date:2015-02-14
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2284813363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110102088AMedicaid
MA110102088AMedicaid