Healthcare Provider Details

I. General information

NPI: 1740258763
Provider Name (Legal Business Name): JING ZHOU CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 S JACKSON ST
LOUISVILLE KY
40202
US

IV. Provider business mailing address

3505 MEADOW CT
LOUISVILLE KY
40218-1324
US

V. Phone/Fax

Practice location:
  • Phone: 520-852-8266
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1099526
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4787A
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3004787
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: