Provider Demographics
NPI:1720849979
Name:RENE, KAYLA (FNP-C)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:RENE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:GRONNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1019 112TH ST SW
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-4875
Mailing Address - Country:US
Mailing Address - Phone:425-268-6250
Mailing Address - Fax:
Practice Address - Street 1:1019 112TH ST SW
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-4875
Practice Address - Country:US
Practice Address - Phone:425-551-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61520536363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner