Healthcare Provider Details

I. General information

NPI: 1730133497
Provider Name (Legal Business Name): BART A RUDD MSN-CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SAINT JOSEPH LN ANESTHESIA PROGRAM
LONDON KY
40741-8345
US

IV. Provider business mailing address

100 E LIBERTY ST SUITE 800
LOUISVILLE KY
40202-1434
US

V. Phone/Fax

Practice location:
  • Phone: 606-330-6000
  • Fax: 606-330-7825
Mailing address:
  • Phone: 606-330-6000
  • Fax: 606-330-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN1080380/ARNP3119A
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1080380
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3119A
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: