Provider Demographics
NPI:1518910231
Name:ZALEWSKI, KENNETH (MSN- CRNA)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:ZALEWSKI
Suffix:
Gender:M
Credentials:MSN- CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12752 KINGSTON PIKE
Mailing Address - Street 2:STE E202
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-0948
Mailing Address - Country:US
Mailing Address - Phone:865-777-0909
Mailing Address - Fax:865-777-0910
Practice Address - Street 1:550 FORT LOUDOUN MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-5673
Practice Address - Country:US
Practice Address - Phone:865-777-0909
Practice Address - Fax:865-777-0910
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN125591/APN10903367500000X
TN125591367500000X
TN10903367500000X
KY6013A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100102190Medicaid
KYP00766419OtherRAILROAD MEDICARE PIN
TN4122993OtherBLUE CROSS/BLUE SHIELD
TN3629056Medicaid
KY000000616080OtherBLUE CROSS/BLUE SHIELD
TNP00355121OtherRAILROAD MEDICARE PIN
TN4122993OtherBCBS TN
KY0907329Medicare PIN
KY7100102190Medicaid