Healthcare Provider Details

I. General information

NPI: 1962473587
Provider Name (Legal Business Name): JAMES E KUZIEL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MED TECH PKWY
JOHNSON CITY TN
37604-4004
US

IV. Provider business mailing address

PO BOX 5665
JOHNSON CITY TN
37602-5665
US

V. Phone/Fax

Practice location:
  • Phone: 423-722-0371
  • Fax: 423-722-0365
Mailing address:
  • Phone: 423-639-0941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License NumberRN053103
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9562
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: