Provider Demographics
NPI:1033248158
Name:WHEELOCK, KEVIN L (CRNA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:L
Last Name:WHEELOCK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 SHORE DR
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-4878
Mailing Address - Country:US
Mailing Address - Phone:360-377-2738
Mailing Address - Fax:
Practice Address - Street 1:711 SHORE DR
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-4878
Practice Address - Country:US
Practice Address - Phone:360-377-2738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200260040367500000X
WAAP30007722367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered