Provider Demographics
NPI:1376538660
Name:EHRET, ROB P (CRNA)
Entity Type:Individual
Prefix:
First Name:ROB
Middle Name:P
Last Name:EHRET
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 1308
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-1308
Mailing Address - Country:US
Mailing Address - Phone:423-224-3460
Mailing Address - Fax:423-224-3465
Practice Address - Street 1:135 W RAVINE RD
Practice Address - Street 2:SUITE 5-B
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3847
Practice Address - Country:US
Practice Address - Phone:423-224-3460
Practice Address - Fax:423-224-3465
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10959367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
4076939OtherBLUE SHIELD OF TN
TN0100OtherJOHN DEERE
00013859OtherNHC CARE ADMINISTRATORS
TN3627149Medicaid
P00156843OtherRAILROAD MEDICARE
KY74008194Medicaid
115988OtherANTHEM BCBS
115988OtherANTHEM BCBS