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General NPI Number Information
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NPI Number | 1144793191
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Entity Type | Individual
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Provider Name | KYLE H ADAMS CRNA
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Gender | Male
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Dates
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Enumeration Date | 01/02/2019
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Last Update Date | 01/02/2019
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Provider Practice Location Address
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Address Line | 969 LAKELAND DR
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City | JACKSON
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State | MS
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Zip | 39216-4606
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Country | US
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Telephone | 601-200-2000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 235019
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City | MONTGOMERY
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State | AL
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Zip | 36123-5019
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Country | US
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Telephone | 334-279-1450
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Fax | 334-279-1660
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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 | 894362
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License Number State | MS
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