Provider Demographics
NPI:1548520240
Name:DAVIDSON, PATRICK AARON (CRNA)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:AARON
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 56TH AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-0380
Mailing Address - Country:US
Mailing Address - Phone:308-224-2062
Mailing Address - Fax:888-974-5962
Practice Address - Street 1:804 22ND AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-2206
Practice Address - Country:US
Practice Address - Phone:308-455-3600
Practice Address - Fax:888-974-5962
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE101193367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026427500Medicaid
NENA1796003Medicare PIN