Kayla Haug, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

357161 Issued in NY

Practice address

5 Medical Dr
Port Jefferson Station, NY 11776-1601

Phone

(631) 364-9119

NPI assigned

Dec 13, 2023

Reactivated

Apr 21, 2025

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1702425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766188800000",
    "number": "1689442287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 SMITH ST",
            "city": "NESCONSET",
            "state": "NY",
            "postal_code": "117673329",
            "telephone_number": "631-830-7588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 MEDICAL DR",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117761601",
            "telephone_number": "631-364-9119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAUG",
        "first_name": "KAYLA",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-12-13",
        "last_updated": "2025-12-20",
        "certification_date": "2025-12-20",
        "deactivation_date": "2025-03-11",
        "reactivation_date": "2025-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "357161",
            "primary": true
        },
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "NY",
            "license": "798655",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.