Healthcare Provider Details

I. General information

NPI: 1063563682
Provider Name (Legal Business Name): LEONARD JOHN HOHLBEIN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 06/12/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 HOLIDAY LN
FULTON KY
42041-8468
US

IV. Provider business mailing address

1008 W STATE LINE ST
FULTON KY
42041-1263
US

V. Phone/Fax

Practice location:
  • Phone: 270-472-2522
  • Fax:
Mailing address:
  • Phone: 573-686-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1050627
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: