MEDICARE: KYRRA E GRIFFIS CST, CSFA

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	246ZC0007X	Surgical Assistant	72	NE
2	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1568161792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYRRA E GRIFFIS CST, CSFA

Provider Business Mailing Address
First Line	:	4905 W OLD POTASH HWY
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-9026
Country	:	US
Telephone Number	:	308-379-6727
Fax Number	:

Provider Business Practice Location Address
First Line	:	4905 W OLD POTASH HWY
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-9026
Country	:	US
Telephone Number	:	308-379-6727
Fax Number	:

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

Provider Enumeration Date	:	02/27/2023
Last Update Date	:	06/08/2023

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