Provider Demographics
NPI:1720374697
Name:BRUMMITTE NEWCOMB, KAYLA RENEE (FNP-C, BSN, RN)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:RENEE
Last Name:BRUMMITTE NEWCOMB
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Gender:F
Credentials:FNP-C, BSN, RN
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Mailing Address - Street 1:598 JOHN DEERE DR
Mailing Address - Street 2:
Mailing Address - City:MAYNARDVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37807-3212
Mailing Address - Country:US
Mailing Address - Phone:865-745-1868
Mailing Address - Fax:865-745-1873
Practice Address - Street 1:598 JOHN DEERE DR
Practice Address - Street 2:
Practice Address - City:MAYNARDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37807-3212
Practice Address - Country:US
Practice Address - Phone:865-745-1868
Practice Address - Fax:865-745-1873
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2015-04-16
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Provider Licenses
StateLicense IDTaxonomies
TNF0911356363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1527270Medicaid
TN10350I5925Medicare PIN