Basic Information
| Provider Information | |||||||||
| NPI: | 1003523192 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KOALAT ANESTHESIA PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3301 S 14TH ST STE 16180 | ||||||||
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| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 796055015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3256756466 | ||||||||
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| Practice Location | |||||||||
| Address1: | 19010 STONE OAK PKWY | ||||||||
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| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782583225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105755200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2022 | ||||||||
| LastUpdateDate: | 10/31/2022 | ||||||||
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| AuthorizedOfficialLastName: | WATERMAN | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | CRNA, OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5705741992 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
| NPICertificationDate: | 10/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.