Healthcare Provider Details

I. General information

NPI: 1982840138
Provider Name (Legal Business Name): KAYLA L PENNINGTON RN, BSN, MS, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20154 SW TILLAMOOK CT
TUALATIN OR
97062-9176
US

IV. Provider business mailing address

20154 SW TILLAMOOK CT
TUALATIN OR
97062-9176
US

V. Phone/Fax

Practice location:
  • Phone: 503-803-0560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number200541035RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number20116009CRNA
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: