Provider Demographics
NPI:1053320614
Name:STOLWORTHY, CATHY (CRNA)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:STOLWORTHY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2826 PLANTATION CT
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-9173
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1025 NEW MOODY LN
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9154
Practice Address - Country:US
Practice Address - Phone:502-222-3886
Practice Address - Fax:502-222-8647
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYARNP2941A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50006836Medicaid
KY74029414Medicaid
000000369769OtherANTHEM BCBS PAR
000000370633OtherANTHEM BCBS PAR
KY50006836Medicaid
IN0663611Medicare ID - Type UnspecifiedMEDICARE INDIANA
2448034000Medicare ID - Type UnspecifiedMEDICARE HMO
KY0964307Medicare ID - Type UnspecifiedMEDICARE KENTUCKY
KY0663611Medicare ID - Type UnspecifiedMEDICARE KENTUCKY