Provider Demographics
NPI:1376349605
Name:CRUMBLEY, KAYLA MIRIAM ROGERS (RN, CPNP)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MIRIAM ROGERS
Last Name:CRUMBLEY
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1826 HARMONY RD
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-1220
Mailing Address - Country:US
Mailing Address - Phone:501-517-5386
Mailing Address - Fax:
Practice Address - Street 1:3911 MARY ELIZA TRCE NW STE 500
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-1089
Practice Address - Country:US
Practice Address - Phone:678-384-3480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN303304363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics