Provider Demographics
NPI:1871262956
Name:MCMINN, KAYLA E (BSN, RN)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:E
Last Name:MCMINN
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:E
Other - Last Name:ATWOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:3109 CRESTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-9330
Mailing Address - Country:US
Mailing Address - Phone:505-330-9872
Mailing Address - Fax:
Practice Address - Street 1:1201 N BUTLER AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-6355
Practice Address - Country:US
Practice Address - Phone:505-599-8607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-84396163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool