Provider Demographics
NPI:1184807653
Name:BENEDETTO, KYLE C (CRNA)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:C
Last Name:BENEDETTO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 S CEDAR CREST BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6258
Mailing Address - Country:US
Mailing Address - Phone:610-402-9099
Mailing Address - Fax:610-402-9029
Practice Address - Street 1:1200 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6202
Practice Address - Country:US
Practice Address - Phone:610-402-9099
Practice Address - Fax:610-402-9029
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA079367367500000X
PARN-514873-L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA113550OtherGEISINGER
PA1579509OtherGATEWAY
PA3421325000OtherINDEPENDENCE BLUE CROSS
PA2003657OtherFIRST PRIORITY
PA11879379OtherCAQH
PA50073814OtherCAPITAL ADVANTAGE
PA1027799960001Medicaid
PA2003657OtherHIGHMARK
PA9057432OtherAETNA
PA2003657OtherFIRST PRIORITY
PA1027799960001Medicaid