Provider Demographics
NPI:1417223272
Name:BAQUERO, KYLEE BEVIN (CRNA)
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:BEVIN
Last Name:BAQUERO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 PATTON AVE
Mailing Address - Street 2:SUITE 510
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-3319
Mailing Address - Country:US
Mailing Address - Phone:828-210-9386
Mailing Address - Fax:828-210-9388
Practice Address - Street 1:82 PATTON AVE
Practice Address - Street 2:SUITE 510
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-3319
Practice Address - Country:US
Practice Address - Phone:828-210-9386
Practice Address - Fax:828-210-9388
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC190926163W00000X
NC090056367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse