Provider Demographics
NPI:1740288828
Name:WEBB, KENNETH W (CRNA)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:W
Last Name:WEBB
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 1:3478 CATCLAW DR STE 192
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-8224
Mailing Address - Country:US
Mailing Address - Phone:325-260-4840
Mailing Address - Fax:
Practice Address - Street 1:14 HOSPITAL DR STE B
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5289
Practice Address - Country:US
Practice Address - Phone:325-232-6596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX651864367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84990UOtherBLUE CROSS
TX174196902Medicaid
TX86241UOtherBCBSTX
AR99695OtherBLUE CROSS
TX174196902Medicaid
TX86241UOtherBCBSTX
TX8D2680Medicare ID - Type Unspecified