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General NPI Number Information
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NPI Number | 1275647489
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Entity Type | Individual
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Provider Name | JOHN R KILLPACK CRNA
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Gender | Male
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 1303 N MAIN ST
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City | CEDAR CITY
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State | UT
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Zip | 84720-9746
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Country | US
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Telephone | 801-993-9501
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Fax | 801-733-5618
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Provider Business Mailing Address
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Address Line | 2174 N CLIFFROSE CIR
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City | CEDAR CITY
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State | UT
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Zip | 84721-7765
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Country | US
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Telephone | 435-531-6668
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Fax |
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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 | CR001222
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 201807-4406
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License Number State | UT
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