Provider Demographics
NPI:1538132790
Name:SCHMIDT, KENT DOUGLAS (CRNA)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:DOUGLAS
Last Name:SCHMIDT
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 1:901 KINKEAD RD
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-7718
Mailing Address - Country:US
Mailing Address - Phone:918-916-0574
Mailing Address - Fax:918-423-6095
Practice Address - Street 1:901 KINKEAD RD
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-7718
Practice Address - Country:US
Practice Address - Phone:918-916-0574
Practice Address - Fax:918-423-6095
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0048209367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100787330AMedicaid