Provider Demographics
NPI:1578084968
Name:BERRY, KAYLA (CRNA)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:CRNA
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Mailing Address - Street 1:639 NORTH MULBERRY STREET
Mailing Address - Street 2:HEARTLAND ANESTHESIA CONSULTANTS, P.S.C.
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-1931
Mailing Address - Country:US
Mailing Address - Phone:270-737-4600
Mailing Address - Fax:270-737-1722
Practice Address - Street 1:639 NORTH MULBERRY STREET
Practice Address - Street 2:HEARTLAND ANESTHESIA CONSULTANTS, P.S.C.
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-1931
Practice Address - Country:US
Practice Address - Phone:270-737-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY1131732163W00000X
KY3011771367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse