Provider Demographics
NPI:1609844919
Name:KENTON, ALTHEA E (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:ALTHEA
Middle Name:E
Last Name:KENTON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ALTHEA
Other - Middle Name:E
Other - Last Name:GOLDSON-THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7730 YOSEMITE LN
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2323
Mailing Address - Country:US
Mailing Address - Phone:954-270-4181
Mailing Address - Fax:
Practice Address - Street 1:7730 YOSEMITE LN
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-2323
Practice Address - Country:US
Practice Address - Phone:954-270-4181
Practice Address - Fax:954-714-8310
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2063782367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306457300Medicaid
FLG3564YMedicare ID - Type Unspecified
FLG3654ZMedicare ID - Type Unspecified