Provider Demographics
NPI:1578517959
Name:KATZ, STEPHEN R (CRNA)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:KATZ
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 1:777 AVENUE H
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-2260
Mailing Address - Country:US
Mailing Address - Phone:307-754-2267
Mailing Address - Fax:307-754-7731
Practice Address - Street 1:450 MOUNTAIN VIEW ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2212
Practice Address - Country:US
Practice Address - Phone:307-754-2267
Practice Address - Fax:307-754-7731
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4423A367500000X
WY18607.366367500000X
WY18607-0366367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000346417OtherBCBS
KY74008798Medicaid
KY0903633Medicare PIN
KY0935309Medicare PIN
KY74008798Medicaid