Healthcare Provider Details

I. General information

NPI: 1932194792
Provider Name (Legal Business Name): JIMMY L KLUTTS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1385 VISTA LN
CARSON CITY NV
89703-4643
US

IV. Provider business mailing address

1385 VISTA LN
CARSON CITY NV
89703-4643
US

V. Phone/Fax

Practice location:
  • Phone: 775-884-4567
  • Fax: 775-884-4569
Mailing address:
  • Phone: 775-884-4567
  • Fax: 775-884-4569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA000198
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: