Healthcare Provider Details

I. General information

NPI: 1881282390
Provider Name (Legal Business Name): MRS. KILYNN R LEASE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KILYNN SMITH

II. Dates (important events)

Enumeration Date: 01/10/2021
Last Update Date: 01/10/2021
Certification Date: 01/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 NEUSE BLVD
NEW BERN NC
28560-3449
US

IV. Provider business mailing address

PO BOX 14611
NEW BERN NC
28561-4611
US

V. Phone/Fax

Practice location:
  • Phone: 252-633-8111
  • Fax:
Mailing address:
  • Phone: 918-497-0799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number135855
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: