Provider Demographics
NPI:1154059541
Name:WATSON, KAYLA NICOLE (PMNHP-BC)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:NICOLE
Last Name:WATSON
Suffix:
Gender:F
Credentials:PMNHP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 OAK HARBOR BLVD. SUITE B #1034
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458
Mailing Address - Country:US
Mailing Address - Phone:504-350-2800
Mailing Address - Fax:504-354-0850
Practice Address - Street 1:330 OAK HARBOR BLVD
Practice Address - Street 2:SUITE B # 1034
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458
Practice Address - Country:US
Practice Address - Phone:504-350-2800
Practice Address - Fax:504-354-0850
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA226781363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty