Provider Demographics
NPI:1275785867
Name:DEEL, KENNITH J (CRNA)
Entity Type:Individual
Prefix:
First Name:KENNITH
Middle Name:J
Last Name:DEEL
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:213 S JEFFERSON ST STE 625
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-224-5516
Mailing Address - Fax:540-224-5684
Practice Address - Street 1:2900 LAMB CIR
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6344
Practice Address - Country:US
Practice Address - Phone:540-731-2802
Practice Address - Fax:540-731-2230
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2020-11-09
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Provider Licenses
StateLicense IDTaxonomies
VA0000000000367500000X
VA0024168045367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered