Provider Demographics
NPI:1891005427
Name:KREMER, KAYLA (PNP)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:KREMER
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 LAURA K DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-3990
Mailing Address - Country:US
Mailing Address - Phone:636-379-9633
Mailing Address - Fax:
Practice Address - Street 1:102 LAURA K DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-3990
Practice Address - Country:US
Practice Address - Phone:636-379-9633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-16
Last Update Date:2010-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO048392363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics