Provider Demographics
NPI:1417474511
Name:WUEBBELS, KAYLA B (FNP)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:B
Last Name:WUEBBELS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PROFESSIONAL PARK DR STE B
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-5830
Mailing Address - Country:US
Mailing Address - Phone:618-288-1480
Mailing Address - Fax:618-288-2407
Practice Address - Street 1:20 PROFESSIONAL PARK DR STE B
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-5830
Practice Address - Country:US
Practice Address - Phone:618-288-1480
Practice Address - Fax:618-288-2407
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016393363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily