Provider Demographics
NPI:1629648597
Name:GILLIS, KAYLA N (NP)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:N
Last Name:GILLIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:226 BECKER AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-2006
Mailing Address - Country:US
Mailing Address - Phone:401-855-0658
Mailing Address - Fax:
Practice Address - Street 1:10 TRIPPS LN
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-3014
Practice Address - Country:US
Practice Address - Phone:401-654-4120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN02731363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIAPRN02731OtherDOH
RICAPRN02731OtherDOH