Healthcare Provider Details

I. General information

NPI: 1568004968
Provider Name (Legal Business Name): KYLE R WEST CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 VETERANS DR
FLORENCE AL
35630-4928
US

IV. Provider business mailing address

PO BOX 10005
FLORENCE AL
35631-2005
US

V. Phone/Fax

Practice location:
  • Phone: 256-629-1000
  • Fax: 256-768-9775
Mailing address:
  • Phone: 256-335-1643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-144910
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: