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General NPI Number Information
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NPI Number | 1578070793
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Entity Type | Individual
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Provider Name | JEDIDIAH KANE CRNA
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Gender | Male
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Dates
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Enumeration Date | 01/09/2018
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Last Update Date | 01/02/2024
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Provider Practice Location Address
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Address Line | 3401 W GORE BLVD
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City | LAWTON
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State | OK
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Zip | 73505-6332
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Country | US
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Telephone | 158-035-5862
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Fax |
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Provider Business Mailing Address
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Address Line | 825 GREEN GROVE RD
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City | SPRING MILLS
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State | PA
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Zip | 16875-7701
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Country | US
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Telephone | 801-477-5334
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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 | 43-557962-051
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License Number State | KS
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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 | 201889
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License Number State | OK
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