Provider Demographics
NPI:1336570605
Name:CARLSON, KYLA M (CPNP)
Entity Type:Individual
Prefix:
First Name:KYLA
Middle Name:M
Last Name:CARLSON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:KYLA
Other - Middle Name:
Other - Last Name:MCINTOSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:12221 N MOPAC EXPY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2401
Mailing Address - Country:US
Mailing Address - Phone:512-901-4031
Mailing Address - Fax:512-901-3937
Practice Address - Street 1:2400 CEDAR BEND DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5378
Practice Address - Country:US
Practice Address - Phone:512-901-4031
Practice Address - Fax:512-901-3937
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX763905363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX332828801Medicaid
TX344392YR93Medicare PIN