Healthcare Provider Details

I. General information

NPI: 1649591975
Provider Name (Legal Business Name): PATRICK TURNER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PIN OAK LN
KEYSER WV
26726-5908
US

IV. Provider business mailing address

100 PIN OAK LN
KEYSER WV
26726-5908
US

V. Phone/Fax

Practice location:
  • Phone: 304-597-3500
  • Fax: 304-597-3513
Mailing address:
  • Phone: 304-597-3500
  • Fax: 304-597-3513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9253011
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN94382-CRNA
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: