Individual
KAYLEIGH M LAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11143 PARKVIEW PLAZA DR STE 311, FORT WAYNE, IN 46845-1728
(260) 266-8840
(260) 266-8849
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28207483A
IN
363L00000X
Nurse Practitioner
Primary
71007400A
IN
363LF0000X
Family Nurse Practitioner
71007400A
IN
Other
Enumeration date
06/07/2017
Last updated
10/10/2022
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