Provider Demographics
NPI:1003523192
Name:KOALAT ANESTHESIA PLLC
Entity Type:Organization
Organization Name:KOALAT ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNA, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WATERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:325-660-5535
Mailing Address - Street 1:3301 S 14TH ST STE 16180
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-5015
Mailing Address - Country:US
Mailing Address - Phone:325-660-5535
Mailing Address - Fax:
Practice Address - Street 1:19010 STONE OAK PKWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3225
Practice Address - Country:US
Practice Address - Phone:210-575-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-31
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty