Provider Demographics
NPI:1760195978
Name:NORMAN, KAYLEE J (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:KAYLEE
Middle Name:J
Last Name:NORMAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:MS
Other - First Name:KAYLEE
Other - Middle Name:JO
Other - Last Name:WILKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4740 N PENGROVE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-7443
Mailing Address - Country:US
Mailing Address - Phone:208-938-3663
Mailing Address - Fax:
Practice Address - Street 1:4740 N PENGROVE WAY
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83686-7443
Practice Address - Country:US
Practice Address - Phone:208-938-3663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID74797363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health