Healthcare Provider Details

I. General information

NPI: 1437146842
Provider Name (Legal Business Name): SCOTT E KAUFFMAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 BICKETT BLVD
RALEIGH NC
27608-2567
US

IV. Provider business mailing address

509 N BRIGHTLEAF BLVD
SMITHFIELD NC
27577-4407
US

V. Phone/Fax

Practice location:
  • Phone: 919-755-9455
  • Fax:
Mailing address:
  • Phone: 919-755-9455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number134745
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9276267
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: