Provider Demographics
NPI:1710377437
Name:CARR, KAYLA LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:LYNN
Last Name:CARR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16732 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:SMETHPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16749-4018
Mailing Address - Country:US
Mailing Address - Phone:814-558-9845
Mailing Address - Fax:
Practice Address - Street 1:2636 W STATE ST
Practice Address - Street 2:SUITE 409
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1859
Practice Address - Country:US
Practice Address - Phone:716-373-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018270363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant