Healthcare Provider Details

I. General information

NPI: 1811650641
Provider Name (Legal Business Name): GARRETT MCKENNA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 HOSPITAL DR
MADISON TN
37115-5030
US

IV. Provider business mailing address

3900 CROSBY DR APT 201
LEXINGTON KY
40515-1858
US

V. Phone/Fax

Practice location:
  • Phone: 888-248-2042
  • Fax:
Mailing address:
  • Phone: 309-660-3398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number1162865
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.0021184
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: