| Kristopher Caleb Pack, | |
|
100 Angus E Peyton Dr, South Charleston, WV 25303-1600 | |
| (304) 746-2088 | |
| Not Available |
| Full Name | Kristopher Caleb Pack |
|---|---|
| Gender | Male |
| Speciality | Nurse Anesthetist, Certified Registered |
| Location | 100 Angus E Peyton Dr, South Charleston, West Virginia |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750022463 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 163WS0200X | Registered Nurse - School | 97394 (West Virginia) | Secondary |
| 367500000X | Nurse Anesthetist, Certified Registered | 97394 (West Virginia) | Primary |
| Entity Name | Northstar Anesthesia Of West Virginia Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1821448150 PECOS PAC ID: 2668750241 Enrollment ID: O20161102001322 |
| Mailing Address | Practice Location Address |
|---|---|
| Kristopher Caleb Pack, 1575 Arnold Ct, Huntington, WV 25705-2909 Ph: (304) 673-9546 | Kristopher Caleb Pack, 100 Angus E Peyton Dr, South Charleston, WV 25303-1600 Ph: (304) 746-2088 |
Lindsey Rubenstein, Nurse Anesthetist - CR Medicare: Medicare Enrolled Practice Location: 4605 Maccorkle Ave Sw, South Charleston, WV 25309 Phone: 304-766-3600 | |
Bradley S. Persinger, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 80 Rockcrest Dr, South Charleston, WV 25309 Phone: 304-542-3927 Fax: 304-768-2468 | |
Tammy L Cunningham, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 4605 Maccorkle Ave Sw, South Charleston, WV 25309 Phone: 304-766-3600 | |
Jessica Smith, RN Nurse Anesthetist - CR Medicare: Medicare Enrolled Practice Location: 100 Angus E Peyton Dr, South Charleston, WV 25303 Phone: 304-746-2088 | |
Mary E. West, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 4605 Maccorkle Ave Sw, South Charleston, WV 25309 Phone: 304-766-3600 | |
Marnie E. Edwards, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 4605 Maccorkle Ave Sw, South Charleston, WV 25309 Phone: 304-766-3600 | |
Nicholas E. Clark, Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 4605 Maccorkle Ave Sw, South Charleston, WV 25309 Phone: 304-766-3600 |