Healthcare Provider Details

I. General information

NPI: 1124338579
Provider Name (Legal Business Name): KENNETH EUGENE DOYON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S FLOYD ST STE 407
LOUISVILLE KY
40202-1837
US

IV. Provider business mailing address

6141 SWEETBAY DR
CRESTWOOD KY
40014-7766
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-2880
  • Fax:
Mailing address:
  • Phone: 502-265-0091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1073825
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: