Provider Demographics
NPI:1245243187
Name:KANIA, TRACY MARIE (CRNA)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:MARIE
Last Name:KANIA
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 1:3802 STOCKRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-6219
Mailing Address - Country:US
Mailing Address - Phone:502-724-7447
Mailing Address - Fax:
Practice Address - Street 1:601 S FLOYD ST
Practice Address - Street 2:SUITE 407
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1835
Practice Address - Country:US
Practice Address - Phone:502-629-2880
Practice Address - Fax:502-629-2879
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007269367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYQ53444Medicare UPIN
KYK033870Medicare PIN
KY0927121Medicare ID - Type Unspecified