Provider Demographics
NPI:1881602456
Name:ANDERSON, KATHLEEN R (CRNA)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:R
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:R
Other - Last Name:BEINOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:5255 MEMPHIS ST UNIT 107
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80239-5228
Mailing Address - Country:US
Mailing Address - Phone:303-506-6995
Mailing Address - Fax:
Practice Address - Street 1:5255 MEMPHIS ST UNIT 107
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80239-5228
Practice Address - Country:US
Practice Address - Phone:303-506-6995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1159-033367500000X
WI108968-030367500000X
KS55137367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP00245174OtherRR MEDICARE GROUP CQ2303
KS200420720AMedicaid
KS145063Medicare PIN