Individual
KEVIN KETTELLE PYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DNAP
Contact information
Practice address
3300 GALLOWS RD, FALLS CHURCH, VA 22042-3307
(703) 776-2632
Mailing address
1621 WRIGHTSON DR, MC LEAN, VA 22101-5144
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001269196
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
0024178744
VA
Other
Enumeration date
01/09/2020
Last updated
03/10/2020
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