Healthcare Provider Details

I. General information

NPI: 1467173864
Provider Name (Legal Business Name): KAYLA WINFREY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 10/30/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 MEDICAL ST
ALTOONA AL
35952-6468
US

IV. Provider business mailing address

180 MEDICAL ST
ALTOONA AL
35952-6468
US

V. Phone/Fax

Practice location:
  • Phone: 205-386-4341
  • Fax: 205-623-1105
Mailing address:
  • Phone: 205-386-4341
  • Fax: 205-623-1105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-151884
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: