Provider Demographics
NPI:1861597643
Name:KEMMER, KATHLEEN F (CRNA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:F
Last Name:KEMMER
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 1:804 SCOTT NIXON MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2464
Mailing Address - Country:US
Mailing Address - Phone:800-394-4445
Mailing Address - Fax:706-434-8886
Practice Address - Street 1:2727 W. DR. MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:STE #310
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607
Practice Address - Country:US
Practice Address - Phone:813-350-7244
Practice Address - Fax:813-350-7246
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP186079367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL301744300Medicaid
FLG0169OtherBCBS OF FL
FLG0196RMedicare PIN
FLG0196UMedicare PIN
FLG0169OtherBCBS OF FL
FLG0196SMedicare PIN