Provider Demographics
NPI:1821022278
Name:KINGREY, WILLIAM (CRNA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:KINGREY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:KINGREY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:1127 PALMER PL
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-3659
Mailing Address - Country:US
Mailing Address - Phone:979-257-6695
Mailing Address - Fax:
Practice Address - Street 1:1127 PALMER PL
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-3659
Practice Address - Country:US
Practice Address - Phone:979-257-6695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN056652163W00000X
TX656674367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1958425Medicaid
LA1958425Medicaid