Healthcare Provider Details

I. General information

NPI: 1609299007
Provider Name (Legal Business Name): AMELA SPRADLING CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S FLOYD ST
LOUISVILLE KY
40202-1835
US

IV. Provider business mailing address

1904 MANOR HOUSE DR
LOUISVILLE KY
40220-1405
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-2880
  • Fax: 502-629-2879
Mailing address:
  • Phone: 502-608-3089
  • Fax: 502-629-2879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3008461
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: