Provider Demographics
NPI:1154415693
Name:BABCOCK, KENT K (CRNA)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:K
Last Name:BABCOCK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 N MADISON
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-2231
Mailing Address - Country:US
Mailing Address - Phone:979-966-0321
Mailing Address - Fax:979-968-2722
Practice Address - Street 1:353 N MADISON
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-2231
Practice Address - Country:US
Practice Address - Phone:979-966-0321
Practice Address - Fax:979-968-2722
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX036116367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX430064785OtherRR MEDICARE
TX81641UOtherBLUE CROSS BLUE SHIELD PI
TX816414OtherBCBS
TX430064785OtherRR MEDICARE
TX0022899-03Medicare PIN