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General NPI Number Information
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NPI Number | 1124422217
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Entity Type | Individual
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Provider Name | KYLE D. JENNINGS CRNA
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Gender | Male
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Dates
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Enumeration Date | 10/17/2014
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Last Update Date | 10/17/2014
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Provider Practice Location Address
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Address Line | 44201 DEQUINDRE RD
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City | TROY
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State | MI
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Zip | 48085-1117
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Country | US
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Telephone | 248-267-5700
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Fax | 248-267-5703
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Provider Business Mailing Address
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Address Line | 750 STEPHENSON HWY
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City | TROY
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State | MI
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Zip | 48083-1103
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Country | US
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Telephone | 248-577-4995
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Fax | 248-577-3526
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 4704269646
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License Number State | MI
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