KIMBERLY A SLATTERY (NPI# 1255512687) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255512687 |
| Entity Type | Individual |
| Full Name | KIMBERLY A SLATTERY |
| Credential | CRNA |
| Practice Address |
5734 Coventry Ln Fort Wayne IN 46804-7141 |
| Mailing Address |
442 W High St Bryan OH 43506-1681 |
| Practice Telephone | 2604367875 |
| Practice Fax Number | 2604329812 |
| Mailing Telephone | 4196364517 |
| Mailing Fax Number | 4196366438 |
| Enumeration Date | 2007-11-14 |
| Last Update Date | 2014-01-15 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 367500000X | Nurse Anesthetist, Certified Registered | 4704242032 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | MEDICARE RAILROAD | P00477902 | 01 |
| Street Address |
5734 COVENTRY LN |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46804-7141 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457359598 | Susan A Nasri | Anesthesiology | 5734 Coventry Ln, Fort Wayne, IN 46804-7141 | 2005-07-12 |
| 1801338769 | Benjamin Riebesel | Registered Nurse | 5734 Coventry Ln, Fort Wayne, IN 46804-7141 | 2016-11-09 |
| 1841648581 | Steven Moran | Nurse Anesthetist, Certified Registered | 5734 Coventry Ln, Fort Wayne, IN 46804-7141 | 2016-06-02 |
| 1649628553 | Kenny Joe Wallen | Pain Medicine | 5734 Coventry Ln, Fort Wayne, IN 46804-7141 | 2016-06-01 |
| 1033575907 | Kimberly Glendoria Wallen | Nurse Anesthetist, Certified Registered | 5734 Coventry Ln, Fort Wayne, IN 46804-7141 | 2016-01-08 |
| 1619369154 | William Dalling | Nurse Anesthetist, Certified Registered | 5734 Coventry Ln, Fort Wayne, IN 46804-7141 | 2015-02-20 |
| 1124424262 | Danielle Aguilar | Nurse Anesthetist, Certified Registered | 5734 Coventry Ln, Fort Wayne, IN 46804-7141 | 2014-11-18 |
| 1023410222 | Michael J. Phythian | Registered Nurse | 5734 Coventry Ln, Fort Wayne, IN 46804-7141 | 2014-09-18 |
| 1023424462 | Benjamin Wisenbaker | Nurse Anesthetist, Certified Registered | 5734 Coventry Ln, Fort Wayne, IN 46804-7141 | 2014-07-07 |
| 1811303258 | Morgan Wisenbaker | Nurse Anesthetist, Certified Registered | 5734 Coventry Ln, Fort Wayne, IN 46804-7141 | 2014-07-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396350344 | Derek Mumaw | Physical Therapist | 8420 Illinois Rd, Fort Wayne, IN 46804 | 2020-09-15 |
| 1942840228 | Erin M Mason | Behavior Technician | 5601 Coventry Ln, Fort Wayne, IN 46804 | 2020-01-14 |
| 1346880879 | Emily A Abdalla | Behavior Technician | 5601 Coventry Ln., Fort Wayne, IN 46804 | 2020-01-13 |
| 1083265433 | Fort Wayne Endodontics | Dentist | 9407 Illinois Rd, Fort Wayne, IN 46804 | 2019-09-26 |
| 1689140949 | Harrison Dental Group II, LLC | Dentist | 1333 Getz Rd, Fort Wayne, IN 46804 | 2018-10-15 |
| 1346731908 | Erin Nicole Zimmerman | Nurse Practitioner | 10170 Illinois Rd # 14, Fort Wayne, IN 46804 | 2018-05-19 |
| 1417446022 | Mary Harrington | Physical Therapist | 3320 Copper Hill Run, Fort Wayne, IN 46804 | 2018-05-09 |
| 1942701214 | Joshawa Todd Torres | Marriage & Family Therapist | 5651 Coventry Ln # 116, Fort Wayne, IN 46804 | 2018-02-22 |
| 1194235408 | Mitchell Kory Meyer | Specialist/Technologist | 9125 Yellow Tree Ct, Fort Wayne, IN 46804 | 2017-10-02 |
| 1902324916 | Emily Rene Sagstetter | Specialist/Technologist | 6034 Liberty Glade Ct, Fort Wayne, IN 46804 | 2017-08-30 |
| Find all providers in zip 46804 | ||||
| Taxonomy Code | 367500000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Anesthetist, Certified Registered |
| (1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition. |
| Notes: Sources: (1) Council on Certification of Nurse Anesthetists, Park Ridge, IL, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. (2) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 548. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306318175 | Logan Alan Williams | Nurse Anesthetist, Certified Registered | 10315 Dawsons Creek Blvd Ste B, Fort Wayne, IN 46825 | 2018-12-18 |
| 1902344906 | Jonathan Christophersen | Nurse Anesthetist, Certified Registered | 7734 Coventry Lane, Fort Wayne, IN 46804-7141 | 2017-02-09 |
| 1275959868 | Patrick Jomo | Nurse Anesthetist, Certified Registered | 4628 Craftsbury Cir, Fort Wayne, IN 46818-2063 | 2014-03-06 |
| 1992135446 | M B Fletcher Pllc | Nurse Anesthetist, Certified Registered | 7747 W Jefferson Blvd Ste B, Fort Wayne, IN 46804-4135 | 2013-11-20 |
| 1407840721 | Lori L Hockenberry | Nurse Anesthetist, Certified Registered | 5734 Coventry Lane, Fort Wayne, IN 46804-7141 | 2005-09-01 |
| 1831798354 | Dorian Raymone Tate | Nurse Anesthetist, Certified Registered | 7950 W Jefferson Blvd, Fort Wayne, IN 46804-4140 | 2020-10-26 |
| 1477179737 | Mirsad Maglajlic | Nurse Anesthetist, Certified Registered | 5050 N Clinton St, Fort Wayne, IN 46825-5886 | 2020-06-23 |
| 1376164087 | Xuan Quyen Vu | Nurse Anesthetist, Certified Registered | 10315 Dawsons Creek Blvd Ste Ab, Fort Wayne, IN 46825-1912 | 2020-05-04 |
| 1447889548 | Tyler William Russell | Nurse Anesthetist, Certified Registered | 10315 Dawsons Creek Blvd, Fort Wayne, IN 46825-1912 | 2020-04-02 |
| 1356988463 | Alissa Lynn Clawson | Nurse Anesthetist, Certified Registered | 7950 W Jefferson Blvd, Fort Wayne, IN 46804-4140 | 2019-12-09 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46804 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.