Healthcare Provider Details

I. General information

NPI: 1144714429
Provider Name (Legal Business Name): KAYLA LYNN URBAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SIVLEY RD SW
HUNTSVILLE AL
35801-4470
US

IV. Provider business mailing address

23432 PINEY CREEK DR
ATHENS AL
35613-8193
US

V. Phone/Fax

Practice location:
  • Phone: 256-265-1000
  • Fax:
Mailing address:
  • Phone: 256-762-9156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number1-136603
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: