Provider Demographics
NPI:1861902355
Name:ALBAUGH, KYLE WILLIAM (CRNA)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:WILLIAM
Last Name:ALBAUGH
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 1:7124 WINFIELD STRASBURG RD NW
Mailing Address - Street 2:
Mailing Address - City:STRASBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44680-8969
Mailing Address - Country:US
Mailing Address - Phone:330-987-0636
Mailing Address - Fax:
Practice Address - Street 1:2600 6TH ST SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-1702
Practice Address - Country:US
Practice Address - Phone:330-363-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH019576367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered