Individual
PAUL KISUCKY III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
925 S WALNUT ST, LAS CRUCES, NM 88001-3955
(575) 523-6330
Mailing address
205 W BOUTZ RD BLDG 1, LAS CRUCES, NM 88005-3259
(575) 532-7033
(575) 556-7139
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
583176
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C79M
BCBS OF TEXAS
—
05
—
088570902
—
TX
05
—
088570904
—
TX
01
—
84581U
BCBS
TX
01
—
86378U
BCBS OF TEXAS
—
Enumeration date
07/10/2006
Last updated
07/01/2019
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