Provider Demographics
NPI:1679687396
Name:KINROSS, SHAWN F (CRNA)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:F
Last Name:KINROSS
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 1:325 S STACI CT
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-1828
Mailing Address - Country:US
Mailing Address - Phone:435-586-6573
Mailing Address - Fax:
Practice Address - Street 1:1303 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-9746
Practice Address - Country:US
Practice Address - Phone:801-993-9501
Practice Address - Fax:801-733-5872
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT309521-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT100505398OtherFIRST HEALTH
UT107021855101OtherIHC
UT80053OtherPEHP
UTTPRA08339OtherMOLINA
UT2000631OtherUNITED HEALTHCARE
UT200262965SFKOtherEDUCATORS MUTUAL
UTQM0000072386OtherALTIUS
UT20638OtherHEALTHY U
UT809586OtherDESERET MUTUAL