Healthcare Provider Details

I. General information

NPI: 1336476860
Provider Name (Legal Business Name): KIMBERLY SUE BEUTEL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY SUE RICKETT

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 DELCO PARK DR
DAYTON OH
45420-1391
US

IV. Provider business mailing address

3333 BURNET AVE., ML 2001 CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER
CINCINNATI OH
45229-3039
US

V. Phone/Fax

Practice location:
  • Phone: 937-293-8228
  • Fax: 937-293-8229
Mailing address:
  • Phone: 513-636-4408
  • Fax: 513-636-7337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN.285812
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: