Provider Demographics
NPI:1891768271
Name:LOTT, KIRK E (CRNA)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:E
Last Name:LOTT
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 1:1800 SPRING RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-6100
Mailing Address - Country:US
Mailing Address - Phone:530-252-2000
Mailing Address - Fax:530-252-2241
Practice Address - Street 1:1800 SPRING RIDGE DR
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-6100
Practice Address - Country:US
Practice Address - Phone:530-252-2000
Practice Address - Fax:530-252-2241
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR50620367500000X
CA3947367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO67157068Medicaid
NMNM006947OtherBCBS
NMP00124198OtherRR MEDICARE
NM201045802OtherPRESBYTERIAN HP
AZ847402Medicaid
NM63136881Medicaid
NM10008783OtherLOVELACE HP
UTT0043Medicaid
UTT0043Medicaid
CADX127ZMedicare PIN