=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215906532
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENNETH MICHAEL SAUNDERS CRNA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2006
-----------------------------------------------------
Last Update Date | 12/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9300 DEWITT LOOP
-----------------------------------------------------
City | FT BELVOIR
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22060-5285
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-231-3224
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 510 TILLMAN PL UNIT E
-----------------------------------------------------
City | WEST POINT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10996
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-926-5572
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | 562064-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------