Healthcare Provider Details

I. General information

NPI: 1942529193
Provider Name (Legal Business Name): KRIS ANDREW KAUFMANN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12303 DE PAUL DR NORTHWEST ANESTHESIA, LTD
BRIDGETON MO
63044-2512
US

IV. Provider business mailing address

PO BOX 1125
MARYLAND HEIGHTS MO
63043-0125
US

V. Phone/Fax

Practice location:
  • Phone: 314-344-7049
  • Fax: 314-344-7073
Mailing address:
  • Phone: 314-344-7049
  • Fax: 314-344-7073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number142785
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: