Provider Demographics
NPI:1255365680
Name:FLITCRAFT, KATHLEEN (CRNA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:FLITCRAFT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:M
Other - Last Name:SHERON FLITCRAFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 650782
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0782
Mailing Address - Country:US
Mailing Address - Phone:302-733-0806
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:501 W. FRONT ST.
Practice Address - Street 2:
Practice Address - City:ELMER
Practice Address - State:NJ
Practice Address - Zip Code:08318-2101
Practice Address - Country:US
Practice Address - Phone:856-363-1000
Practice Address - Fax:856-358-0994
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0028494163W00000X
NJ26NO11053100163W00000X
NJ26NJ00238000367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00795659OtherRAILROAD MEDICARE PTAN
NJ075412OtherAANA NUMBER
NJP00795659OtherRAILROAD MEDICARE PTAN