Provider Demographics
NPI:1679627624
Name:MOOK, RONALD KEVIN (CRNA)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:KEVIN
Last Name:MOOK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 CONSTITUTION CT
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27523-6749
Mailing Address - Country:US
Mailing Address - Phone:919-454-3864
Mailing Address - Fax:
Practice Address - Street 1:231 CONSTITUTION CT
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27523-6749
Practice Address - Country:US
Practice Address - Phone:919-454-3864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC164209367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8051524Medicaid
NC430069455OtherRAILROAD-MEDICARE
NC430069455OtherRAILROAD-MEDICARE