Healthcare Provider Details

I. General information

NPI: 1548506082
Provider Name (Legal Business Name): JENNIFER MARIE BLESER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER KOHLER CRNA

II. Dates (important events)

Enumeration Date: 01/02/2013
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL VILLAGE DR
EDGEWOOD KY
41017-3403
US

IV. Provider business mailing address

340 THOMAS MORE PKWY SUITE 220
CRESTVIEW HILLS KY
41017-5101
US

V. Phone/Fax

Practice location:
  • Phone: 859-341-7246
  • Fax: 859-341-7867
Mailing address:
  • Phone: 859-341-2666
  • Fax: 859-341-7867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1094324
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1094324
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: