Basic Information
| Provider Information | |||||||||
| NPI: | 1255878138 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PFEIFER | ||||||||
| FirstName: | ADAM | ||||||||
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| Credential: | CNRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2209 OUTER CIRCLE DR | ||||||||
| Address2: | |||||||||
| City: | CRESTWOOD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 400149113 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 601 S FLOYD ST | ||||||||
| Address2: | SUITE 407 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026292880 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2017 | ||||||||
| LastUpdateDate: | 01/30/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 3011063 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.