Provider Demographics
NPI:1124265590
Name:BLACK, KRISTOPHER A (CRNA)
Entity type:Individual
Prefix:MR
First Name:KRISTOPHER
Middle Name:A
Last Name:BLACK
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Gender:M
Credentials:CRNA
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Mailing Address - Street 1:PO BOX 1155
Mailing Address - Street 2:ATTN AQREVA
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59103-1155
Mailing Address - Country:US
Mailing Address - Phone:719-557-3824
Mailing Address - Fax:719-557-3834
Practice Address - Street 1:1008 MINNEQUA AVE
Practice Address - Street 2:OR/ANESTHESIOLOGY
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3733
Practice Address - Country:US
Practice Address - Phone:719-557-3824
Practice Address - Fax:719-557-3834
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2021-07-08
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Provider Licenses
StateLicense IDTaxonomies
WY47932367500000X
CO121197367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered