Healthcare Provider Details

I. General information

NPI: 1801714613
Provider Name (Legal Business Name): MICHAEL DOUGLAS OSBORNE CRNA, DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST
LEXINGTON KY
40536-7001
US

IV. Provider business mailing address

3829 LEXINGTON RD
WINCHESTER KY
40391-9527
US

V. Phone/Fax

Practice location:
  • Phone: 859-749-2442
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberFL086
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: