Healthcare Provider Details

I. General information

NPI: 1154623825
Provider Name (Legal Business Name): MICHAEL KENNETH KITE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2010
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MEDICAL VILLAGE DR STE 258 INDEPENDENT ANESTHESIOLOGISTS
EDGEWOOD KY
41017-5401
US

IV. Provider business mailing address

28 GLENRIDGE DR
COLD SPRING KY
41076-9086
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-2211
  • Fax:
Mailing address:
  • Phone: 513-807-2332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number86720
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1112744
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: