Provider Demographics
NPI:1639584600
Name:BOTH, STEPHEN K JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:K
Last Name:BOTH
Suffix:JR
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:3301 S 14TH ST STE 16180
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-5015
Mailing Address - Country:US
Mailing Address - Phone:325-675-6466
Mailing Address - Fax:325-692-6030
Practice Address - Street 1:208 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-9755
Practice Address - Country:US
Practice Address - Phone:325-660-5535
Practice Address - Fax:325-692-6030
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2020-11-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN28216719367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered