Provider Demographics
NPI:1407414352
Name:PATEL, ANKUR (CRNA)
Entity Type:Individual
Prefix:
First Name:ANKUR
Middle Name:
Last Name:PATEL
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 1:1712 HOURGLASS PT
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-3298
Mailing Address - Country:US
Mailing Address - Phone:423-400-0027
Mailing Address - Fax:
Practice Address - Street 1:4960 NORTON HEALTHCARE BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2831
Practice Address - Country:US
Practice Address - Phone:502-446-8125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN195106163W00000X
KY3014022367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse