Basic Information
Provider Information | |||||||||
NPI: | 1346240108 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ENGLISH | ||||||||
FirstName: | ROBERT | ||||||||
MiddleName: | JUDD | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | CRNA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ENGLISH | ||||||||
OtherFirstName: | ROBERT | ||||||||
OtherMiddleName: | JUDD | ||||||||
OtherNamePrefix: | MR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | CRNA | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 800 ROSE STREET | ||||||||
Address2: | DEPT OF ANESTHESIOLOGY CHANDLER MEDICAL CENTER | ||||||||
City: | LEXINGTON | ||||||||
State: | KY | ||||||||
PostalCode: | 40536 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8593235956 | ||||||||
FaxNumber: | 8593231080 | ||||||||
Practice Location | |||||||||
Address1: | 800 ROSE STREET | ||||||||
Address2: | DEPT OF ANESTHESIOLOGY CHANDLER MEDICAL CENTER | ||||||||
City: | LEXINGTON | ||||||||
State: | KY | ||||||||
PostalCode: | 40536 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8593235956 | ||||||||
FaxNumber: | 8593231080 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/22/2005 | ||||||||
LastUpdateDate: | 02/22/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 3005992 | KY | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   |
ID Information
ID | Type | State | Issuer | Description | 74008004 | 05 | KY |   | MEDICAID | 3635050 | 05 | TN |   | MEDICAID | 4072297 | 01 | TN | BCBS NUMBER | OTHER | 009941605 | 05 | AL |   | MEDICAID |