Provider Demographics
NPI:1215020094
Name:ROYAL, GAIL YOUNT (CRNA)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:YOUNT
Last Name:ROYAL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:
Other - Last Name:YOUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:255 ENTERPRISE BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-6300
Mailing Address - Country:US
Mailing Address - Phone:864-454-0888
Mailing Address - Fax:864-454-1130
Practice Address - Street 1:701 GROVE RD
Practice Address - Street 2:ANESTHESIA DEPT
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-5611
Practice Address - Country:US
Practice Address - Phone:864-455-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPRN 357367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC20015732OtherSELECT HEALTH
SCAN0212Medicaid
SCQ32257Medicare ID - Type UnspecifiedMEDICARE