Provider Demographics
NPI:1306579503
Name:EMERICK, KAYLA F
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:F
Last Name:EMERICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 S WALTON BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7533
Mailing Address - Country:US
Mailing Address - Phone:479-464-0834
Mailing Address - Fax:479-464-0836
Practice Address - Street 1:1720 S WALTON BLVD STE 6
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7533
Practice Address - Country:US
Practice Address - Phone:479-464-0834
Practice Address - Fax:479-464-0836
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
ARPA-1372363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant