MEDICARE: JOHN BRAUGHTON CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	4598A	KY

General Provider Information

NPI Number	:	1962404467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN BRAUGHTON CRNA

Provider Business Mailing Address
First Line	:	3320 TATES CREEK RD
Second Line	:	SUITE 204
City	:	LEXINGTON
State	:	KY
Zip	:	40502-3400
Country	:	US
Telephone Number	:	859-268-1030
Fax Number	:	859-269-4120

Provider Business Practice Location Address
First Line	:	1107 W LEXINGTON AVE
Second Line	:
City	:	WINCHESTER
State	:	KY
Zip	:	40391-1169
Country	:	US
Telephone Number	:	859-745-3500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	07/08/2007

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