Provider Demographics
NPI:1295117521
Name:TYSINGER, KATHRYN KELLY (CRNA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:KELLY
Last Name:TYSINGER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:MICHELLE
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:539 POWER PLANT CIR
Mailing Address - Street 2:LOFT 347
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-4188
Mailing Address - Country:US
Mailing Address - Phone:919-451-9594
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:919-451-9594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC225399367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered