Healthcare Provider Details

I. General information

NPI: 1477280600
Provider Name (Legal Business Name): CODY VANCE SCOVEL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 05/24/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 WILHITE DR
LEXINGTON KY
40503-3385
US

IV. Provider business mailing address

430 BARKLEY DR
LEXINGTON KY
40503-1849
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-0185
  • Fax:
Mailing address:
  • Phone: 860-316-7212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP61328552
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: