NPI 1174796601

Timothy Paul Kordick, CRNA

Practitioner Certified Registered Nurse Anesthetist Poplar Bluff, MO

Practice location

Address: 2620 N Westwood Blvd, Poplar Bluff, MO 63901-3396
Phone: (573) 686-4111
Mailing address: PO Box 88, Poplar Bluff, MO 63902-0088

Registered specialties

Certified Registered Nurse Anesthetist Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 367500000X Licence 2004031215 (MO)

Other Nurse Anesthetist, Certified Registered providers in Missouri →

Registry record

NPI: 1174796601
Entity type: Individual
Sex (as registered): Male
NPI issued: 4 Apr 2008
Record last updated: 4 Apr 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.