Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kristopher Caleb Pack

Individual provider School Registered Nurse · NPI 1750022463

Kristopher Caleb Pack is a Certified Registered Nurse Anesthetist (CRNA) in South Charleston, West Virginia. Qualified in 2024, 2 years ago. Practices with Northstar Anesthesia of West Virginia PLLC, a 124-clinician group and accepts Medicare assignment. Licensed in West Virginia.

Years since qualifying
2
Licensed in
WV
In the registry since
2022
Specialties on file
2

Practice location Address checks out

100 Angus E Peyton Dr
South Charleston, WV 25303-1600
Phone: (304) 746-2088
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence 97394 (WV)
School Registered Nurse Taxonomy 163WS0200X · Licence 97394 (WV)

Record details

NPI number1750022463
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedApril 5, 2022
Last updated in NPPESAugust 21, 2024
Certification dateAugust 21, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Northstar Anesthesia Of West Virginia Pllc — 124 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount