Healthcare Provider Details

I. General information

NPI: 1659372142
Provider Name (Legal Business Name): JAMES L CATHELYN JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 05/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 BYPASS RD
PIKEVILLE KY
41501-1689
US

IV. Provider business mailing address

PO BOX 2917
PIKEVILLE KY
41502-2917
US

V. Phone/Fax

Practice location:
  • Phone: 606-218-3500
  • Fax: 606-218-4562
Mailing address:
  • Phone: 606-218-3500
  • Fax: 606-218-4562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN0000046140
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3007421
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: