Healthcare Provider Details

I. General information

NPI: 1265762454
Provider Name (Legal Business Name): CAILEY SCRUGGS KOONCE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2010
Last Update Date: 08/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SIVLEY RD SW
HUNTSVILLE AL
35801-4421
US

IV. Provider business mailing address

101 SIVLEY RD SW
HUNTSVILLE AL
35801-4421
US

V. Phone/Fax

Practice location:
  • Phone: 256-265-9639
  • Fax: 256-265-7767
Mailing address:
  • Phone: 256-265-9639
  • Fax: 256-265-7767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9297226
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number811702
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-109346
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: