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General NPI Number Information
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NPI Number | 1295117521
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Entity Type | Individual
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Provider Name | KATHRYN KELLY TYSINGER CRNA
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Gender | Female
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Dates
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Enumeration Date | 06/23/2015
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Last Update Date | 06/23/2015
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Provider Practice Location Address
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Address Line | 1 MEDICAL CENTER BLVD
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City | WINSTON SALEM
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State | NC
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Zip | 27157-0001
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Country | US
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Telephone | 919-451-9594
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Fax |
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Provider Business Mailing Address
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Address Line | 539 POWER PLANT CIR LOFT 347
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City | WINSTON SALEM
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State | NC
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Zip | 27101-4188
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Country | US
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Telephone | 919-451-9594
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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 | 225399
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License Number State | NC
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