Provider Demographics
NPI:1063591816
Name:MYERS, KARON RAE (CRNA)
Entity type:Individual
Prefix:MS
First Name:KARON
Middle Name:RAE
Last Name:MYERS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 VIRGINIA AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2242
Mailing Address - Country:US
Mailing Address - Phone:304-925-5743
Mailing Address - Fax:304-925-5743
Practice Address - Street 1:401 SIXTH AVENUE
Practice Address - Street 2:MONTGOMERY GENERAL HOSPITAL
Practice Address - City:MONTGOMERY
Practice Address - State:WV
Practice Address - Zip Code:25136-0270
Practice Address - Country:US
Practice Address - Phone:304-442-1331
Practice Address - Fax:304-442-1324
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17919163W00000X
WV28083367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0065161000Medicaid
WVMY7295781Medicare ID - Type Unspecified
A00092Medicare UPIN