MEDICARE: MR. JOHN WARREN KILPATRICK 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	513337	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	83757U	OTHER	TX	BCBSTX

General Provider Information

NPI Number	:	1922005180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN WARREN KILPATRICK CRNA

Provider Business Mailing Address
First Line	:	313 MEDITERRANEAN DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78418-2905
Country	:	US
Telephone Number	:	361-937-8603
Fax Number	:	361-937-8821

Provider Business Practice Location Address
First Line	:	313 MEDITERRANEAN DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78418-2905
Country	:	US
Telephone Number	:	361-937-8603
Fax Number	:	361-937-8821

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

Provider Enumeration Date	:	07/03/2005
Last Update Date	:	10/29/2007

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