Provider Demographics
NPI:1255173969
Name:GREGG, KAILA MARIE (PMHNP)
Entity type:Individual
Prefix:
First Name:KAILA
Middle Name:MARIE
Last Name:GREGG
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20019 W MAZATZAL DR
Mailing Address - Street 2:
Mailing Address - City:WITTMANN
Mailing Address - State:AZ
Mailing Address - Zip Code:85361-5015
Mailing Address - Country:US
Mailing Address - Phone:623-850-6611
Mailing Address - Fax:
Practice Address - Street 1:20019 W MAZATZAL DR
Practice Address - Street 2:
Practice Address - City:WITTMANN
Practice Address - State:AZ
Practice Address - Zip Code:85361-5015
Practice Address - Country:US
Practice Address - Phone:623-850-6611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ308001363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health