Healthcare Provider Details

I. General information

NPI: 1538132790
Provider Name (Legal Business Name): KENT DOUGLAS SCHMIDT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 KINKEAD RD
MCALESTER OK
74501-7718
US

IV. Provider business mailing address

901 KINKEAD RD
MCALESTER OK
74501-7718
US

V. Phone/Fax

Practice location:
  • Phone: 918-916-0574
  • Fax: 918-423-6095
Mailing address:
  • Phone: 918-916-0574
  • Fax: 918-423-6095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR0048209
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: