Basic Information
Provider Information
NPI: 1790403129
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VOSS
FirstName: KAYLA
MiddleName: E
NamePrefix:  
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 12 JAMES PL
Address2:  
City: FREDONIA
State: NY
PostalCode: 140631331
CountryCode: US
TelephoneNumber: 7166795638
FaxNumber:  
Practice Location
Address1: 107 INSTITUTE ST
Address2:  
City: JAMESTOWN
State: NY
PostalCode: 147016628
CountryCode: US
TelephoneNumber: 7164844334
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/22/2022
LastUpdateDate: 08/22/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/22/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP2300XF349478-01NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care

No ID Information.


Home