1043539984 NPI number — CARRIE ANNE ROBERTS CRNA

Table of content: CARRIE ANNE ROBERTS CRNA (NPI 1043539984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043539984 NPI number — CARRIE ANNE ROBERTS CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTS
Provider First Name:
CARRIE
Provider Middle Name:
ANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAILY
Provider Other First Name:
CARRIE
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043539984
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3053 AUTUMN HILL TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ALBANY
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47150-9468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-718-5927
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3053 AUTUMN HILL TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ALBANY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47150-9468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-718-5927
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/18/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  083715 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1077148 . This is a "RN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".