MEDICARE: KENTRY S ADAMS 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	163W00000X	Registered Nurse	RN10647	TN
2	367500000X	Certified Registered Nurse Anesthetist	28156078A	IN
3	367500000X	Certified Registered Nurse Anesthetist	051663	TN
4	367500000X	Certified Registered Nurse Anesthetist	APN10647	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4055319	OTHER	TN	BC/BS OF TN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	3157794	OTHER	TN	BCBS NUMBER

General Provider Information

NPI Number	:	1376542803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENTRY S ADAMS CRNA

Provider Business Mailing Address
First Line	:	PO BOX 291264
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37229-1264
Country	:	US
Telephone Number	:	615-620-2320
Fax Number	:	615-620-2323

Provider Business Practice Location Address
First Line	:	1265 EAST COLLEGE STREET
Second Line	:
City	:	PULASKI
State	:	TN
Zip	:	38478
Country	:	US
Telephone Number	:	615-620-2320
Fax Number	:	615-620-2323

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	01/23/2019

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Directions to “ KENTRY S ADAMS CRNA” Practice Location

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