Healthcare Provider Details

I. General information

NPI: 1356411003
Provider Name (Legal Business Name): KEVIN LEO RHODEN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 12/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 N FRESNO ST YOSEMITE 2
FRESNO CA
93720-2941
US

IV. Provider business mailing address

7300 N FRESNO ST
FRESNO CA
93720-2941
US

V. Phone/Fax

Practice location:
  • Phone: 559-448-2501
  • Fax:
Mailing address:
  • Phone: 559-816-6872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12593
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3211
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: