Provider Demographics
NPI:1376542803
Name:ADAMS, KENTRY S (CRNA)
Entity Type:Individual
Prefix:
First Name:KENTRY
Middle Name:S
Last Name:ADAMS
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 291264
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37229-1264
Mailing Address - Country:US
Mailing Address - Phone:615-620-2320
Mailing Address - Fax:615-620-2323
Practice Address - Street 1:1265 EAST COLLEGE STREET
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478
Practice Address - Country:US
Practice Address - Phone:615-620-2320
Practice Address - Fax:615-620-2323
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN10647163W00000X
IN28156078A367500000X
TN051663367500000X
TNAPN10647367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009944020Medicaid
TN4055319OtherBC/BS OF TN
TN3631090Medicaid
KY74002445Medicaid
TN3157794OtherBCBS NUMBER
TN3157794OtherBCBS NUMBER
KY74002445Medicaid