Provider Demographics
NPI:1518410067
Name:HANSEN, KAYLA J (APRN)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:J
Last Name:HANSEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-4316
Mailing Address - Country:US
Mailing Address - Phone:918-298-2264
Mailing Address - Fax:918-298-0923
Practice Address - Street 1:701 E MAIN ST
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-4316
Practice Address - Country:US
Practice Address - Phone:918-298-2264
Practice Address - Fax:918-298-0923
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK106781363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200668950AMedicaid