Provider Demographics
NPI:1851809982
Name:SHNOWSKI, KYLE ANDREW (CRNA)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:ANDREW
Last Name:SHNOWSKI
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1501 E MOCKINGBIRD LN STE 101
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-2178
Mailing Address - Country:US
Mailing Address - Phone:361-573-6291
Mailing Address - Fax:361-576-2434
Practice Address - Street 1:2701 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901
Practice Address - Country:US
Practice Address - Phone:361-573-6291
Practice Address - Fax:361-576-2434
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX840899163W00000X
TXAP136211367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse