Provider Demographics
NPI:1710092788
Name:KIRKLAND, KENNETH CLAYTON (CRNA)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:CLAYTON
Last Name:KIRKLAND
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 1:824 SAXON CT
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-4519
Mailing Address - Country:US
Mailing Address - Phone:817-297-0125
Mailing Address - Fax:
Practice Address - Street 1:824 SAXON CT
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-4519
Practice Address - Country:US
Practice Address - Phone:817-297-0125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX601348367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered