Provider Demographics
NPI:1558458141
Name:CASON, KIRK DELMO (CRNA)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:DELMO
Last Name:CASON
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 1:1 ST MARY PLACE
Mailing Address - Street 2:PFS - PROFESSIONAL BILLING
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101
Mailing Address - Country:US
Mailing Address - Phone:318-681-6878
Mailing Address - Fax:318-681-6753
Practice Address - Street 1:1 ST MARY PLACE
Practice Address - Street 2:PFS - PROFESSIONAL BILLING
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101
Practice Address - Country:US
Practice Address - Phone:318-681-6878
Practice Address - Fax:318-681-6753
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN73218367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1562882Medicaid
LA1562882Medicaid