MEDICARE: KENNETH CORDER 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	AP124947	TX

General Provider Information

NPI Number	:	1689095564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH CORDER CRNA

Provider Business Mailing Address
First Line	:	PO BOX 650865
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75265-0865
Country	:	US
Telephone Number	:	972-715-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	13737 NOEL RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-1331
Country	:	US
Telephone Number	:	972-715-5000
Fax Number	:

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

Provider Enumeration Date	:	12/19/2013
Last Update Date	:	12/08/2025

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