Provider Demographics
NPI:1508484890
Name:BABB-DICUS, KAYLA (FNP)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:BABB-DICUS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:BABB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1008 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-5044
Mailing Address - Country:US
Mailing Address - Phone:573-472-7423
Mailing Address - Fax:573-472-7475
Practice Address - Street 1:123 SMITH AVE
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5239
Practice Address - Country:US
Practice Address - Phone:573-471-0200
Practice Address - Fax:573-471-7559
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020020510363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily