Provider Demographics
NPI:1922529171
Name:MCMAHILL, KAYLA ROSE (PNP)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:ROSE
Last Name:MCMAHILL
Suffix:
Gender:F
Credentials:PNP
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-454-6050
Mailing Address - Fax:855-887-7850
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DIV PED INFECTIOUS DISEASE
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6050
Practice Address - Fax:855-887-7850
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2017019604363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420045157Medicaid