Healthcare Provider Details

I. General information

NPI: 1588569818
Provider Name (Legal Business Name): ALEXANDRIA FAITH LUSH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 STATE ST
NEW ALBANY IN
47150-4990
US

IV. Provider business mailing address

12915 OBSERVATION CIR UNIT 204
LOUISVILLE KY
40243-1675
US

V. Phone/Fax

Practice location:
  • Phone: 812-944-7701
  • Fax:
Mailing address:
  • Phone: 502-552-3655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4063968
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: