Provider Demographics
NPI:1083680318
Name:GREER, KENNETH GLEN (CRNA)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:GLEN
Last Name:GREER
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 1:1538 N HOBART ST # 4330
Mailing Address - Street 2:
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79065-4126
Mailing Address - Country:US
Mailing Address - Phone:806-665-2868
Mailing Address - Fax:806-665-2641
Practice Address - Street 1:ONE MEDICAL PLAZA
Practice Address - Street 2:
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065
Practice Address - Country:US
Practice Address - Phone:806-663-5504
Practice Address - Fax:806-663-5514
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX248844367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G1314Medicare ID - Type Unspecified