Provider Demographics
NPI:1033414370
Name:CRASE, CAROL ANN (APRN)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:CRASE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 WHITTINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4904
Mailing Address - Country:US
Mailing Address - Phone:502-423-7246
Mailing Address - Fax:502-292-5755
Practice Address - Street 1:252 WHITTINGTON PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4904
Practice Address - Country:US
Practice Address - Phone:502-423-7246
Practice Address - Fax:502-292-5755
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006793363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100586400Medicaid