Provider Demographics
NPI:1689617979
Name:KEARNEY, DEBRA L (CRNA)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:KEARNEY
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 1:12 VILLA EST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-9760
Mailing Address - Country:US
Mailing Address - Phone:304-549-1238
Mailing Address - Fax:
Practice Address - Street 1:12 VILLA EST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-9760
Practice Address - Country:US
Practice Address - Phone:304-549-1238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV48426367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0200409000Medicaid
WV0200409000Medicaid
WV8222194Medicare PIN
WV001721840OtherBCBS
WV27005299701OtherWORKERS COMP
WV0009971000Medicaid
WV0207026000Medicaid
WV2602050000Medicaid
WV270052997002OtherTRICARE
WV0200409000Medicaid
WV9333201Medicare PIN
WV001721840OtherMSBCBS
WVDA0096OtherRR MEDICARE
WV001706470OtherMSBCBS
WVP00001162OtherRR MEDICARE