Provider Demographics
NPI:1538438635
Name:HEUSNER, KYLA (MD)
Entity type:Individual
Prefix:DR
First Name:KYLA
Middle Name:
Last Name:HEUSNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2812 54TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-4610
Mailing Address - Country:US
Mailing Address - Phone:727-867-8641
Mailing Address - Fax:727-867-6795
Practice Address - Street 1:2812 54TH AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-4610
Practice Address - Country:US
Practice Address - Phone:727-867-8641
Practice Address - Fax:727-867-6795
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME121651207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine