Individual
KAYLA D SOUTHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1101 PROFESSIONAL BLVD STE 100, EVANSVILLE, IN 47714-8018
(812) 477-7246
(812) 477-7240
Mailing address
1101 PROFESSIONAL BLVD STE 100, EVANSVILLE, IN 47714-8018
(812) 477-7246
(812) 477-7240
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3015194
KY
363LF0000X
Family Nurse Practitioner
71011015A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300058612
—
IN
05
—
7100794440
—
KY
Enumeration date
11/10/2020
Last updated
05/17/2022
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