Provider Demographics
NPI:1811513369
Name:PERJAK, KAYLEA BETH (CPNP-PC)
Entity type:Individual
Prefix:
First Name:KAYLEA
Middle Name:BETH
Last Name:PERJAK
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1965 S FREMONT AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2283
Mailing Address - Country:US
Mailing Address - Phone:417-820-0280
Mailing Address - Fax:
Practice Address - Street 1:1965 S FREMONT AVE STE 220
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2283
Practice Address - Country:US
Practice Address - Phone:417-820-0280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-21
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020017475363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics