Healthcare Provider Details

I. General information

NPI: 1073123766
Provider Name (Legal Business Name): KAYLA GOINS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SIVLEY RD SW
HUNTSVILLE AL
35801-4470
US

IV. Provider business mailing address

7802 SPRINGBROOK DR SE
HUNTSVILLE AL
35802-3322
US

V. Phone/Fax

Practice location:
  • Phone: 256-265-1000
  • Fax:
Mailing address:
  • Phone: 256-683-8870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-136294
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: