Provider Demographics
NPI:1871001727
Name:BAUMAN, BLAKE KYLE (DNP, CRNA)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:KYLE
Last Name:BAUMAN
Suffix:
Gender:M
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 W MCDERMOTT DR # 116-371
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6510
Mailing Address - Country:US
Mailing Address - Phone:469-541-1600
Mailing Address - Fax:469-541-1612
Practice Address - Street 1:4510 MEDICAL CENTER DR STE 211
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1602
Practice Address - Country:US
Practice Address - Phone:469-541-1600
Practice Address - Fax:469-541-1612
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-12
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0004263-C-CRNA367500000X
TXAP136204367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered