Provider Demographics
NPI:1275171423
Name:GREENWOOD, KAILANI ALANA LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:KAILANI
Middle Name:ALANA LEE
Last Name:GREENWOOD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KAILANI
Other - Middle Name:ALANA LEE
Other - Last Name:DECOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:301 BROWN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7005
Mailing Address - Country:US
Mailing Address - Phone:334-747-4159
Mailing Address - Fax:
Practice Address - Street 1:4160 CARMICHAEL RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3638
Practice Address - Country:US
Practice Address - Phone:334-747-7440
Practice Address - Fax:334-747-7449
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA1169477363A00000X
AL1862363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant