Provider Demographics
NPI:1134446552
Name:WINKLEBLACK, LAURA KAILEY (CRNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:KAILEY
Last Name:WINKLEBLACK
Suffix:
Gender:
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 N 12TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2837
Mailing Address - Country:US
Mailing Address - Phone:602-839-6040
Mailing Address - Fax:602-839-3411
Practice Address - Street 1:1441 N 12TH ST FL 2
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2837
Practice Address - Country:US
Practice Address - Phone:602-839-6040
Practice Address - Fax:602-839-3411
Is Sole Proprietor?:No
Enumeration Date:2010-04-24
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA011021163W00000X
PARN594783163WX0800X
AZAP4521363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
No163WX0800XNursing Service ProvidersRegistered NurseOrthopedic