MEDICARE: MR. KEVIN JAMES COOLONG CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	0024164868	VA

General Provider Information

NPI Number	:	1316947310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEVIN JAMES COOLONG CRNA

Provider Business Mailing Address
First Line	:	644 CORBY GLEN AVE
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23322-1005
Country	:	US
Telephone Number	:	757-390-6294
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 GRESHAM DR
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23507-1904
Country	:	US
Telephone Number	:	757-473-0055
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	10/29/2012

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