=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851950315
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CRANDALL KYLE VARNELL MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2019
-----------------------------------------------------
Last Update Date | 05/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18511 HIGHLANDER MEDICS ST
-----------------------------------------------------
City | FORT BLISS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79906-5327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-742-2273
-----------------------------------------------------
Fax | 915-742-0080
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6748 CABANA DEL SOL
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79911-3015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-540-0107
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 0116032970
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------