Provider Demographics
NPI:1336741404
Name:DOLIVEIRA, KAYLA D (NP)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:D
Last Name:DOLIVEIRA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:KOPCZYNSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-944-7728
Practice Address - Fax:317-274-2940
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28234172A163W00000X
IN71011883A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse