Healthcare Provider Details

I. General information

NPI: 1932174976
Provider Name (Legal Business Name): ARIC BRENDAN DEYOUNG CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W CENTRAL
EL DORADO KS
67092
US

IV. Provider business mailing address

PO BOX 388
NEWTON KS
67114-0388
US

V. Phone/Fax

Practice location:
  • Phone: 316-321-3300
  • Fax:
Mailing address:
  • Phone: 316-281-3700
  • Fax: 316-282-4322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2019030581
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number55084
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: