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General NPI Number Information
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NPI Number | 1871016014
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Entity Type | Individual
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Provider Name | KAYLA NICOLE GREGORY DNP, CRNA
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Gender | Female
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Dates
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Enumeration Date | 07/19/2017
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 1 KISH HOSPITAL DR
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City | DEKALB
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State | IL
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Zip | 60115-9602
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Country | US
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Telephone | 815-756-7521
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Fax |
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Provider Business Mailing Address
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Address Line | 24617 S GOLDFINCH CT
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City | CHANNAHON
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State | IL
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Zip | 60410-9767
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Country | US
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Telephone | 331-330-5011
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041.403602
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 209016996
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License Number State | IL
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