Healthcare Provider Details

I. General information

NPI: 1194644591
Provider Name (Legal Business Name): CODY JAMES DILLOW CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 NICHOLASVILLE RD
LEXINGTON KY
40503-1431
US

IV. Provider business mailing address

215 JARED PARKER WAY
GEORGETOWN KY
40324-7087
US

V. Phone/Fax

Practice location:
  • Phone: 859-260-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1159056
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: