Provider Demographics
NPI:1770255481
Name:KAYLOR, ANGELA BROOKE (NP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:BROOKE
Last Name:KAYLOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 LAMBTOWN RD
Mailing Address - Street 2:
Mailing Address - City:CAVE IN ROCK
Mailing Address - State:IL
Mailing Address - Zip Code:62919-2123
Mailing Address - Country:US
Mailing Address - Phone:618-638-2931
Mailing Address - Fax:
Practice Address - Street 1:6 FERRELL RD
Practice Address - Street 2:
Practice Address - City:ROSICLARE
Practice Address - State:IL
Practice Address - Zip Code:62982-1052
Practice Address - Country:US
Practice Address - Phone:618-285-6634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.024116363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care