Kenneth Donald Klos Jr., CRNA
Individual provider Active NPI Certified Registered Nurse Anesthetist · Cook, MN
NPI 1386646115 · NPPES record last updated Sep 29, 2011
Key facts
- NPI
- 1386646115
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- R076202-1 (MN)
- Practice address
- 7595 Timberlore TRL
Cook, MN 55723-8728 - Phone
- (218) 290-4381
- NPI assigned
- Aug 11, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R076202-1 | MN | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grand Itasca Clinic and Hospital | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | R076202-1 | MN | Yes |
Addresses
Primary practice location
7595 Timberlore TRL
Cook, MN 55723-8728
Mailing address
7595 Timberlore TRL
Cook, MN 55723-8728
Phone (218) 290-4381
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 891043000 | Medicaid | MN |
Other providers in Cook, MN
- Harpreet Kaur
- Amy Kemp
- Erin Margret Kennedy
- William Brian Keute
- Melanie Liisa Kiehm
- Krista L. Kukarans
- Stephanie Rae Lantry
- Milo Ljosenvoor
- Anthony Menart
- Jeri Mills
All providers in Cook, MN · Certified Registered Nurse Anesthetist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 29, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.