MEDICARE: KAYLA LEA CAMPBELL CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	D095688	IA

General Provider Information

NPI Number	:	1497868152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA LEA CAMPBELL CRNA

Provider Business Mailing Address
First Line	:	512 RIVER OAK DR
Second Line	:
City	:	AMES
State	:	IA
Zip	:	50010-4755
Country	:	US
Telephone Number	:	515-451-3747
Fax Number	:

Provider Business Practice Location Address
First Line	:	512 RIVER OAK DR
Second Line	:
City	:	AMES
State	:	IA
Zip	:	50010-4755
Country	:	US
Telephone Number	:	515-451-3747
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	10/06/2017

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