Provider Demographics
NPI:1790206688
Name:RAUSCH, KAYLA GRACE (FNP)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:GRACE
Last Name:RAUSCH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2423 W DUNLAP AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-5818
Mailing Address - Country:US
Mailing Address - Phone:602-279-5351
Mailing Address - Fax:602-279-5361
Practice Address - Street 1:2423 W DUNLAP AVE STE 140
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-5818
Practice Address - Country:US
Practice Address - Phone:602-279-5351
Practice Address - Fax:602-279-5361
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10306363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily