Provider Demographics
NPI:1881348464
Name:OTTEY, KAYLA (CRNP-PC)
Entity type:Individual
Prefix:MISS
First Name:KAYLA
Middle Name:
Last Name:OTTEY
Suffix:
Gender:F
Credentials:CRNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 GREEN VALLEY WAY
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-2529
Mailing Address - Country:US
Mailing Address - Phone:267-885-9802
Mailing Address - Fax:
Practice Address - Street 1:217 GREEN VALLEY WAY
Practice Address - Street 2:
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-2529
Practice Address - Country:US
Practice Address - Phone:267-885-9802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-11
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175M00000X
PASP023915363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
No175M00000XOther Service ProvidersMidwife, LayGroup - Single Specialty