Basic Information
| Provider Information | |||||||||
| NPI: | 1760423255 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WINGER | ||||||||
| FirstName: | KATHLEEN | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1824 WALTON WAY | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309043804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067379250 | ||||||||
| FaxNumber: | 7067330697 | ||||||||
| Practice Location | |||||||||
| Address1: | 1350 WALTON WAY | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309012612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067379250 | ||||||||
| FaxNumber: | 7067330697 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 04/18/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN043065 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | P00339775 | 01 | GA | RAILROAD MEDICARE | OTHER | GAN175 | 05 | SC | MEDICAID |