Provider Demographics
NPI:1487079711
Name:HUMPHRIES, KAYLA MARIE (CRNP)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:HUMPHRIES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2705
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-2705
Mailing Address - Country:US
Mailing Address - Phone:256-265-4595
Mailing Address - Fax:256-265-4599
Practice Address - Street 1:221 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:RED BAY
Practice Address - State:AL
Practice Address - Zip Code:35582-3858
Practice Address - Country:US
Practice Address - Phone:256-356-8907
Practice Address - Fax:256-356-8903
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-116495363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner