NPIMap

Organization Active NPI

Dynamic Anesthesia, PLLC

  • Certified Registered Nurse Anesthetist
  • Center Conway, NH
National Provider Identifier
1952596751
Registry record updated Jun 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
DYNAMIC ANESTHESIA, PLLC
Practice address
1564 Brownfield Rd
Center Conway, NH 03813
Phone
(603) 387-4523
Fax
(866) 394-0351
NPI assigned
Sep 14, 2007
Last updated
Jun 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Kelly Catherine Defeo, CRNA, FNP-BC
Title
Owner
Phone
(603) 387-4523

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 04717023-11 NH
Certified Registered Nurse Anesthetist 367500000X NH Primary
Specialist 174400000X 047170-23-11 NH

Addresses

Primary practice location

1564 Brownfield Rd
Center Conway, NH 03813

Mailing address

1564 Brownfield Rd
Center Conway, NH 03813
Phone (603) 387-4523

Other identifiers 1

IdentifierTypeStateIssuer
3079830MedicaidNH

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591142400000",
    "number": "1952596751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1564 BROWNFIELD RD",
            "city": "CENTER CONWAY",
            "state": "NH",
            "postal_code": "03813",
            "telephone_number": "603-387-4523",
            "fax_number": "866-394-0351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1564 BROWNFIELD RD",
            "city": "CENTER CONWAY",
            "state": "NH",
            "postal_code": "03813",
            "telephone_number": "603-387-4523",
            "fax_number": "866-394-0351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC ANESTHESIA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-14",
        "last_updated": "2020-06-03",
        "certification_date": "2020-06-03",
        "status": "A",
        "authorized_official_last_name": "DEFEO",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "CATHERINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "603-387-4523",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CRNA, FNP-BC"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NH",
            "license": "04717023-11",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NH",
            "license": null,
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NH",
            "license": "047170-23-11",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3079830",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Center Conway, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.