1952900565 NPI number — KAYLA MCKENNA STRATTON AG-ACNP, RN

Table of content: KAYLA MCKENNA STRATTON AG-ACNP, RN (NPI 1952900565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952900565 NPI number — KAYLA MCKENNA STRATTON AG-ACNP, RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STRATTON
Provider First Name:
KAYLA
Provider Middle Name:
MCKENNA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AG-ACNP, RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MEYERS
Provider Other First Name:
KAYLA
Provider Other Middle Name:
MCKENNA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952900565
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3288 MOANALUA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96819-1469
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-432-0000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3288 MOANALUA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96819-1469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-432-0000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2100X , with the licence number:  2020014011 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: APRN-4748 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: APRN-4748 . This is a "HAWAII STATE LICENSE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: RN-120643 . This is a "HAWAII STATE LICENSE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 2020014011 . This is a "AGACNP-BC" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: RN197325 . This is a "RN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".