Provider Demographics
NPI:1477889103
Name:SPUHLER, KEVIN K (CRNA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:K
Last Name:SPUHLER
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 1:2259 E COLE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3956
Mailing Address - Country:US
Mailing Address - Phone:619-253-1833
Mailing Address - Fax:
Practice Address - Street 1:2259 E COLE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3956
Practice Address - Country:US
Practice Address - Phone:619-253-1833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-31
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX589996367500000X, 163WC0200X
CA3886367500000X
CA507451163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01212744OtherRR MEDICARE
TX1477889103OtherBCBS OF TX
TX211568503Medicaid
TX295700YK3EMedicare PIN