Provider Demographics
NPI:1649230376
Name:DEAS, KATHRYN HAMILTON (CRNA)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:HAMILTON
Last Name:DEAS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 12TH ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4158
Mailing Address - Country:US
Mailing Address - Phone:601-703-9687
Mailing Address - Fax:601-703-9920
Practice Address - Street 1:1800 12TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4158
Practice Address - Country:US
Practice Address - Phone:601-703-9687
Practice Address - Fax:601-703-9920
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-078939207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP00180318OtherRAILROAD MEDICARE
AL051554345Medicaid
AL051519296OtherBCBS OF AL
ALP00180318OtherRAILROAD MEDICARE