Provider Demographics
NPI:1144288333
Name:KENNINGTON, KATHRYN HALE (CRNA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:HALE
Last Name:KENNINGTON
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 1:967 PAULK ROAD
Mailing Address - Street 2:
Mailing Address - City:RAMER
Mailing Address - State:AL
Mailing Address - Zip Code:36069-6362
Mailing Address - Country:US
Mailing Address - Phone:334-562-3399
Mailing Address - Fax:
Practice Address - Street 1:967 PAULK ROAD
Practice Address - Street 2:
Practice Address - City:RAMER
Practice Address - State:AL
Practice Address - Zip Code:36069-6362
Practice Address - Country:US
Practice Address - Phone:334-562-3399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-030956367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009933874Medicaid
AL009933874Medicaid
AL051556793Medicare ID - Type Unspecified