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General NPI Number Information
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NPI Number | 1548244478
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Entity Type | Individual
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Provider Name | KEVIN HANNAH CRNA
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Gender | Male
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Dates
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Enumeration Date | 12/05/2005
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Last Update Date | 06/09/2009
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Provider Practice Location Address
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Address Line | 4415 E FALCON DR
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-7436
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Country | US
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Telephone | 479-527-0705
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Fax |
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Provider Business Mailing Address
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Address Line | 4415 E FALCON DR
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-7436
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Country | US
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Telephone | 479-527-0705
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | R66986
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License Number State | AR
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