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General NPI Number Information
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NPI Number | 1770107583
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Entity Type | Individual
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Provider Name | KALEB ANDREW BURGESS CRNA
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Gender | Male
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Dates
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Enumeration Date | 06/08/2020
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Last Update Date | 03/01/2024
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Provider Practice Location Address
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Address Line | 4401 RIVERCHASE DR
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City | PHENIX CITY
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State | AL
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Zip | 36867-7483
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Country | US
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Telephone | 334-732-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 6225 N STATE HIGHWAY 161 STE 200
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City | IRVING
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State | TX
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Zip | 75038-2241
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Country | US
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Telephone |
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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 | 1-149764
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License Number State | AL
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