Provider Demographics
NPI:1912375296
Name:SMITH, KYLE ROBERT (CRNA)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:ROBERT
Last Name:SMITH
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 1:5641 SW FOXCROFT CIR S APT 204
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-4130
Mailing Address - Country:US
Mailing Address - Phone:785-806-1417
Mailing Address - Fax:
Practice Address - Street 1:823 SW MULVANE ST STE 210
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1679
Practice Address - Country:US
Practice Address - Phone:785-235-3451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-03
Last Update Date:2016-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS115184163W00000X
KS557381367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse