=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437146842
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCOTT E KAUFFMAN CRNA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2005
-----------------------------------------------------
Last Update Date | 04/15/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 BICKETT BLVD
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27608-2567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-755-9455
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 509 N BRIGHTLEAF BLVD
-----------------------------------------------------
City | SMITHFIELD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27577-4407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-755-9455
-----------------------------------------------------
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 | 134745
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | APRN9276267
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------