MEDICARE: MR. KEVIN LEO RHODEN CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	12593	CA
2	367500000X	Certified Registered Nurse Anesthetist	3211	CA

General Provider Information

NPI Number	:	1356411003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEVIN LEO RHODEN CRNA

Provider Business Mailing Address
First Line	:	7300 N FRESNO ST
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-2941
Country	:	US
Telephone Number	:	559-816-6872
Fax Number	:

Provider Business Practice Location Address
First Line	:	7300 N FRESNO ST
Second Line	:	YOSEMITE 2
City	:	FRESNO
State	:	CA
Zip	:	93720-2941
Country	:	US
Telephone Number	:	559-448-2501
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	12/30/2021

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