Healthcare Provider Details

I. General information

NPI: 1275848145
Provider Name (Legal Business Name): BRANDON K WARD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2010
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 KY ROUTE 321
PRESTONSBURG KY
41653-9113
US

IV. Provider business mailing address

272 HOSPITAL RD
CHILLICOTHEE OH
45601-9031
US

V. Phone/Fax

Practice location:
  • Phone: 606-886-8511
  • Fax:
Mailing address:
  • Phone: 740-779-7540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3006266
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: