Provider Demographics
NPI:1962476739
Name:RHODUS, KEVIN M (CRNA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:RHODUS
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 1:6 WAPITI LOOP
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-7124
Mailing Address - Country:US
Mailing Address - Phone:505-947-6660
Mailing Address - Fax:
Practice Address - Street 1:1397 WEIMER RD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6253
Practice Address - Country:US
Practice Address - Phone:575-758-8883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0000892-C-CRNA367500000X
NMR54743367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM10020355OtherLOVELACE HP
CO59332841Medicaid
UTT0426Medicaid
AZ956899Medicaid
NM202000353OtherPRESBYTERIAN HP
NMNM006B15OtherBCBS
NM9829750Medicaid
NMP00329269OtherRR MEDICARE
CO59332841Medicaid