Healthcare Provider Details

I. General information

NPI: 1144313834
Provider Name (Legal Business Name): RICK ABBOTT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 04/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 FAIRWAY DR
HAYS KS
67601-1576
US

IV. Provider business mailing address

3701 FARIWAY DR
HAYS KS
67601-1576
US

V. Phone/Fax

Practice location:
  • Phone: 785-769-4416
  • Fax:
Mailing address:
  • Phone: 785-621-4793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number54093
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: