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General NPI Number Information
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NPI Number | 1851467526
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Entity Type | Individual
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Provider Name | BEVERLY JO CRADY CST CFA
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Gender | Female
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1520 SANDERS LANE
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City | LOUISVILLE
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State | KY
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Zip | 40216
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Country | US
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Telephone | 502-366-5965
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Fax | 502-361-6637
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Provider Business Mailing Address
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Address Line | 1520 SANDERS LANE
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City | LOUISVILLE
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State | KY
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Zip | 40216
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Country | US
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Telephone | 502-366-5965
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Fax | 502-361-6637
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 92630
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License Number State | KY
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