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NPI Code Detail

MEDICARE: MR. KENNETH PATTON SPEAK CRNA

MEDICARE: MR. KENNETH PATTON SPEAK 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
1367500000XCertified Registered Nurse Anesthetist33147VA

General Provider Information

NPI Number : 1780753137
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KENNETH PATTON SPEAK CRNA
Provider Business Mailing Address
First Line : 999 EXECUTIVE PARK BLVD
Second Line : SUITE 201
City : KINGSPORT
State : TN
Zip : 37660-4632
Country : US
Telephone Number : 423-224-3250
Fax Number : 423-224-3258
Provider Business Practice Location Address
First Line : 127 HEALTH CARE DR
Second Line :
City : PENNINGTON GAP
State : VA
Zip : 24277-2853
Country : US
Telephone Number : 276-546-1440
Fax Number : 276-546-5759
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2006
Last Update Date : 10/21/2022

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