Provider Demographics
NPI:1043293277
Name:GABEHART, H LEWIS (CRNA)
Entity Type:Individual
Prefix:
First Name:H
Middle Name:LEWIS
Last Name:GABEHART
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W OWL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-8947
Mailing Address - Country:US
Mailing Address - Phone:270-465-6676
Mailing Address - Fax:
Practice Address - Street 1:800 ROSE ST # N217
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-8947
Practice Address - Country:US
Practice Address - Phone:859-323-5956
Practice Address - Fax:859-323-1080
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1061711163W00000X
TNRN0000047222163W00000X
TNAPN0000008996367500000X
KY1239A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74346677Medicaid
KY0693320Medicare ID - Type Unspecified
KYCR00076Medicare ID - Type Unspecified