Provider Demographics
NPI:1962477711
Name:DORTLAND, KAYLA S (ARNP-C)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:S
Last Name:DORTLAND
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 ELMHURST BLVD
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-7406
Mailing Address - Country:US
Mailing Address - Phone:785-827-2500
Mailing Address - Fax:785-827-2515
Practice Address - Street 1:2707 VINE ST
Practice Address - Street 2:STE10
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-1949
Practice Address - Country:US
Practice Address - Phone:785-628-3231
Practice Address - Fax:785-628-3174
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44885363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060527OtherBCBS (HAYS LOCATION)
KS500018012OtherTRAVELERS MEDICARE
KS160547OtherBCBS (GREAT BEND LOCATION
KS161033OtherBCBS (SALINA LOCATION)
KS623450OtherFIRST GUARD
KS500018012OtherTRAVELERS MEDICARE
KS060527OtherBCBS (HAYS LOCATION)
KS060527Medicare ID - Type UnspecifiedHAYS LOCATION