Provider Demographics
NPI:1780753137
Name:SPEAK, KENNETH PATTON (CRNA)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:PATTON
Last Name:SPEAK
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:999 EXECUTIVE PARK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4632
Mailing Address - Country:US
Mailing Address - Phone:423-224-3250
Mailing Address - Fax:423-224-3258
Practice Address - Street 1:127 HEALTH CARE DR
Practice Address - Street 2:
Practice Address - City:PENNINGTON GAP
Practice Address - State:VA
Practice Address - Zip Code:24277-2853
Practice Address - Country:US
Practice Address - Phone:276-546-1440
Practice Address - Fax:276-546-5759
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2022-10-21
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Provider Licenses
StateLicense IDTaxonomies
VA33147367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004051P50Medicare PIN
VAP00622792Medicare PIN
VA015927W82Medicare PIN