Individual
KAYLA PAVAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1342 BELMONT ST, BROCKTON, MA 02301-4436
(508) 973-7041
Mailing address
1342 BELMONT ST, BROCKTON, MA 02301-4436
(508) 973-7041
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
APRN01989
RI
363L00000X
Nurse Practitioner
Primary
RN2286207
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MR1050296N
MASS CONTROLLED SUBSTANCE REGISTRATION
MA
01
—
RN2286207
CERTIFIED NURSE PRACTITIONER
MA
Enumeration date
08/02/2016
Last updated
02/08/2019
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