Healthcare Provider Details

I. General information

NPI: 1134492747
Provider Name (Legal Business Name): BENJAMIN THOMAS KABEL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 LANGDON ST
SOMERSET KY
42503-2750
US

IV. Provider business mailing address

132 INDEPENDENCE WAY
SCIENCE HILL KY
42553-7456
US

V. Phone/Fax

Practice location:
  • Phone: 606-678-7441
  • Fax:
Mailing address:
  • Phone: 270-535-4407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3007331
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: