Healthcare Provider Details

I. General information

NPI: 1649208687
Provider Name (Legal Business Name): THOMAS RUSSELL SLONE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 11TH ST
CARROLLTON KY
41008-1435
US

IV. Provider business mailing address

309 11TH ST
CARROLLTON KY
41008-1435
US

V. Phone/Fax

Practice location:
  • Phone: 502-732-3278
  • Fax: 502-732-9050
Mailing address:
  • Phone: 502-732-3278
  • Fax: 502-732-9050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1059054
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: