Healthcare Provider Details

I. General information

NPI: 1225146327
Provider Name (Legal Business Name): KEVIN JAMES RYAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E ARAPAHOE ST HOT SPRINGS COUNTY MEMORIAL HOSPITAL
THERMOPOLIS WY
82443-2402
US

IV. Provider business mailing address

290 W RIVER RD
WORLAND WY
82401-9747
US

V. Phone/Fax

Practice location:
  • Phone: 307-864-5023
  • Fax: 307-864-5039
Mailing address:
  • Phone: 307-347-3204
  • Fax: 307-864-5039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number16571.0656
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: