Provider Demographics
NPI:1568213643
Name:WOLFE, KAYLEE JO (APRN)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:JO
Last Name:WOLFE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KAYLEE
Other - Middle Name:JO
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1848
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-1841
Mailing Address - Country:US
Mailing Address - Phone:888-710-8220
Mailing Address - Fax:866-573-0761
Practice Address - Street 1:3312 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2304
Practice Address - Country:US
Practice Address - Phone:888-710-8220
Practice Address - Fax:866-573-0761
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR227035363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily