| Doctor Name: | KENNY JOE WALLEN |
| NPI Number: | 1649628553 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.N.P. |
| License Number: | 108299 |
| Business Practice Address: | 5734 Coventry Ln Fort Wayne, IN - 468047141 |
| Business Phone Number: | 2604329812 |
| Business Fax Number: | |
| Mailing Address: | 4170 Frost Grass Dr, FORT WAYNE |
| State: | IN |
| Postal Code: | 468458009 |
| Phone Number: | 9189061697 |
| Fax Number: | |
| NPI Enumeration Date: | 06/01/2016 |
| NPI Last Update Date: | 06/01/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 367500000X |
| License Number: | 108299 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Anesthetist, Certified Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition. |