Provider Demographics
NPI:1780244145
Name:CORNELL, KAYLA MARY (FNP)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARY
Last Name:CORNELL
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:755 JEFFERSON RD STE 110
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-3270
Mailing Address - Country:US
Mailing Address - Phone:315-463-0421
Mailing Address - Fax:
Practice Address - Street 1:6713 COLLAMER RD STE 100
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9814
Practice Address - Country:US
Practice Address - Phone:315-463-0421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY344428363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily