Provider Demographics
NPI:1275932501
Name:ALEXANDER, KEVIN THOMAS (CRNA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:THOMAS
Last Name:ALEXANDER
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 1:2000 E. LAMAR BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006
Mailing Address - Country:US
Mailing Address - Phone:817-583-7434
Mailing Address - Fax:682-227-6861
Practice Address - Street 1:2000 E. LAMAR BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006
Practice Address - Country:US
Practice Address - Phone:817-583-7434
Practice Address - Fax:682-227-6861
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS557279367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered