Individual
CAROLYN FRANCES KENNGOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1171 W TARGET RANGE RD, NOGALES, AZ 85621-2415
(520) 285-3000
Mailing address
2202 N FORBES BLVD, TUCSON, AZ 85745-1412
(520) 872-7536
(520) 872-7929
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
CRNA0689
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
599761
—
AZ
01
—
Z145034
MEDICARE PTAN
AZ
Enumeration date
04/03/2006
Last updated
01/10/2012
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