1336476860 NPI number — KIMBERLY SUE BEUTEL CRNA

Table of content: KIMBERLY SUE BEUTEL CRNA (NPI 1336476860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336476860 NPI number — KIMBERLY SUE BEUTEL CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEUTEL
Provider First Name:
KIMBERLY
Provider Middle Name:
SUE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RICKETT
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
SUE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336476860
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3333 BURNET AVE., ML 2001
Provider Second Line Business Mailing Address:
CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45229-3039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-636-4408
Provider Business Mailing Address Fax Number:
513-636-7337

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3533 SOUTHERN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KETTERING
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45429-1264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-293-8228
Provider Business Practice Location Address Fax Number:
937-293-8229
Provider Enumeration Date:
11/04/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  RN.285812 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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