Healthcare Provider Details

I. General information

NPI: 1952372328
Provider Name (Legal Business Name): JOHN FREDERICK KYCEY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2434 S PLAYA
MESA AZ
85202-6925
US

IV. Provider business mailing address

2434 S PLAYA
MESA AZ
85202-6925
US

V. Phone/Fax

Practice location:
  • Phone: 480-730-6329
  • Fax: 480-730-0178
Mailing address:
  • Phone: 480-730-6329
  • Fax: 480-730-0178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP1931182
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN065393
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: