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General NPI Number Information
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NPI Number | 1598061053
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Entity Type | Individual
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Provider Name | CHRISTOPHER DOUGLAS KYLE CRNA
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Gender | Male
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Dates
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Enumeration Date | 02/01/2011
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Last Update Date | 03/23/2015
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Provider Practice Location Address
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Address Line | 3600 JOSEPH SIEWICK DR
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City | FAIRFAX
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State | VA
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Zip | 22033-1709
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Country | US
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Telephone | 703-664-7048
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Fax | 703-644-7402
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Provider Business Mailing Address
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Address Line | 68 S SERVICE RD
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City | MELVILLE
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State | NY
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Zip | 11747-2358
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Country | US
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Telephone | 516-945-3000
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Fax | 516-945-3131
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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 | 0024169251
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License Number State | VA
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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 | R191518
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | NA4420
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License Number State | CA
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