Provider Demographics
NPI:1316171838
Name:GENRICH, KAYLA MICHELLE (CRNA)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MICHELLE
Last Name:GENRICH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 S CLIFF AVE
Mailing Address - Street 2:PO BOX 5045, P.F.S.
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1007
Mailing Address - Country:US
Mailing Address - Phone:605-322-2796
Mailing Address - Fax:
Practice Address - Street 1:1325 S CLIFF AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1007
Practice Address - Country:US
Practice Address - Phone:605-322-2796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD-CRNA CR000718367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1316171838Medicaid
NE46022474348Medicaid
9280739OtherDAKOTACARE
1316171838OtherWELLMARK BCBS-SD/TRICARE
SD5756310Medicaid
1316171838OtherMN BC
IA1316171838Medicaid
SDP00883867OtherRAILROAD MEDICARE
MN1316171838Medicaid