Individual
KYLE E. EWING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4916 OVERTON PLZ, FORT WORTH, TX 76109
(888) 804-3000
(817) 334-0235
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
630008
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C17Y
BLUE CROSS BLUE SHIELD
TX
05
—
156081503
—
TX
05
—
156081505
—
TX
01
—
8122UU
BCBS
TX
Enumeration date
12/06/2006
Last updated
06/07/2018
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