Provider Demographics
NPI:1669184503
Name:GAMMILL, KAYLA LEANN (APRN)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:LEANN
Last Name:GAMMILL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:LEANN
Other - Last Name:PENSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1166 S BLUE WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-7977
Mailing Address - Country:US
Mailing Address - Phone:479-461-5293
Mailing Address - Fax:
Practice Address - Street 1:300 HOSPITAL PARKWAY
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274
Practice Address - Country:US
Practice Address - Phone:360-424-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61216638363LF0000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily