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General NPI Number Information
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NPI Number | 1700262870
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Entity Type | Individual
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Provider Name | KENNETH AYTES CRNA
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Gender | Male
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Dates
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Enumeration Date | 07/30/2015
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Last Update Date | 02/18/2026
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Provider Practice Location Address
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Address Line | 2817 REILLY ST
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City | FORT BRAGG
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State | NC
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Zip | 28310-7324
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Country | US
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Telephone | 910-907-7668
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Fax |
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Provider Business Mailing Address
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Address Line | 2817 ROCK MERRITT AVE
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City | FORT BRAGG
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State | NC
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Zip | 28310-0001
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Country | US
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Telephone | 910-907-8707
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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 | 145078
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License Number State | TN
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