Provider Demographics
NPI:1407431695
Name:TURCO, KAYLA R
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:R
Last Name:TURCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:414-435-0025
Mailing Address - Fax:414-435-0026
Practice Address - Street 1:4225 W OAKWOOD PARK CT
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-8131
Practice Address - Country:US
Practice Address - Phone:414-435-0025
Practice Address - Fax:414-435-0026
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5521363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100177585Medicaid