Provider Demographics
NPI:1053965764
Name:HARGRAVES, KYLA DANIELLE (APRN)
Entity type:Individual
Prefix:
First Name:KYLA
Middle Name:DANIELLE
Last Name:HARGRAVES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 SE PARK ST
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-2967
Mailing Address - Country:US
Mailing Address - Phone:863-763-1107
Mailing Address - Fax:
Practice Address - Street 1:204 SE PARK ST
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-2967
Practice Address - Country:US
Practice Address - Phone:863-763-1107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11002701363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily