MEDICARE: KYLE CLIFFTON DENNIS 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	367500000X	Certified Registered Nurse Anesthetist	C01542	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891807947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE CLIFFTON DENNIS CRNA

Provider Business Mailing Address
First Line	:	PO BOX 11286
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72917-1286
Country	:	US
Telephone Number	:	479-785-2555
Fax Number	:	479-785-3555

Provider Business Practice Location Address
First Line	:	2910 JENNY LIND RD
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-6735
Country	:	US
Telephone Number	:	479-785-2555
Fax Number	:	479-785-3555

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	06/04/2009

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