Provider Demographics
NPI:1114220100
Name:GREGORY, ERICA M (CRNA)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:M
Last Name:GREGORY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:PADGETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 740041
Mailing Address - Street 2:DEPT 5090
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-7441
Mailing Address - Country:US
Mailing Address - Phone:502-451-9949
Mailing Address - Fax:502-451-4553
Practice Address - Street 1:231 E CHESTNUT ST
Practice Address - Street 2:KOSAIR CHILDRENS HOSPITAL
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1821
Practice Address - Country:US
Practice Address - Phone:502-451-9949
Practice Address - Fax:502-451-4553
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1104127367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered