Healthcare Provider Details

I. General information

NPI: 1548342678
Provider Name (Legal Business Name): KIMBERLY SCHOENECK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 CHADWICK DR
JACKSON MS
39204-3404
US

IV. Provider business mailing address

150 BLUFF AVE
NORTH AUGUSTA SC
29841-3862
US

V. Phone/Fax

Practice location:
  • Phone: 601-376-1848
  • Fax: 601-376-1894
Mailing address:
  • Phone: 800-394-4445
  • Fax: 706-396-3252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR858155
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: