Provider Demographics
NPI:1811246275
Name:CROSS, KAYLA ELISE CAPIZZANO (NP)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:ELISE CAPIZZANO
Last Name:CROSS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-0040
Mailing Address - Country:US
Mailing Address - Phone:508-909-7799
Mailing Address - Fax:508-764-2432
Practice Address - Street 1:255 E OLD STURBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRIMFIELD
Practice Address - State:MA
Practice Address - Zip Code:01010-9647
Practice Address - Country:US
Practice Address - Phone:413-245-0966
Practice Address - Fax:413-245-4553
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005049363LF0000X
MA2270500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0053436OtherCSP
CT12.005049OtherAPRN