MEDICARE: KEVIN HANNAH 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	207L00000X	Anesthesiology Physician	R66986	AR

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

General Provider Information

NPI Number	:	1548244478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN HANNAH CRNA

Provider Business Mailing Address
First Line	:	4415 E FALCON DR
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72701-7436
Country	:	US
Telephone Number	:	479-527-0705
Fax Number	:

Provider Business Practice Location Address
First Line	:	4415 E FALCON DR
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72701-7436
Country	:	US
Telephone Number	:	479-527-0705
Fax Number	:

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

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	06/09/2009

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Directions to “ KEVIN HANNAH CRNA” Practice Location

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