Provider Demographics
NPI:1346652922
Name:GORE, KAYLA L (CRNA)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:L
Last Name:GORE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:L
Other - Last Name:CHOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:705 KRISTANNA DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-3274
Mailing Address - Country:US
Mailing Address - Phone:850-319-4139
Mailing Address - Fax:
Practice Address - Street 1:4250 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-1917
Practice Address - Country:US
Practice Address - Phone:850-482-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9278587163W00000X
FLARNP9278587367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG01PTOtherBCBSFL
FLHV025ZMedicare PIN