Provider Demographics
NPI:1073758637
Name:MCCAFFREY, KEVIN J (CRNA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:MCCAFFREY
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:PO BOX 725
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326
Mailing Address - Country:US
Mailing Address - Phone:607-547-3153
Mailing Address - Fax:607-547-6539
Practice Address - Street 1:ONE ATWELL ROAD
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326
Practice Address - Country:US
Practice Address - Phone:607-547-3153
Practice Address - Fax:607-547-6539
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY544536367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered