Provider Demographics
NPI:1891807947
Name:DENNIS, KYLE CLIFFTON (CRNA)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:CLIFFTON
Last Name:DENNIS
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:PO BOX 11286
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-1286
Mailing Address - Country:US
Mailing Address - Phone:479-785-2555
Mailing Address - Fax:479-785-3555
Practice Address - Street 1:2910 JENNY LIND RD
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-6735
Practice Address - Country:US
Practice Address - Phone:479-785-2555
Practice Address - Fax:479-785-3555
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC01542367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR159007001Medicaid
OK200073830AMedicaid
OK200073830AMedicaid