Provider Demographics
NPI:1467441022
Name:PRATHER, TROY A (CRNA)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:A
Last Name:PRATHER
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 1:1001 MAIN ST # K3502
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1009
Mailing Address - Country:US
Mailing Address - Phone:716-323-6570
Mailing Address - Fax:716-323-6658
Practice Address - Street 1:1001 MAIN ST # K3502
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1009
Practice Address - Country:US
Practice Address - Phone:716-323-6570
Practice Address - Fax:716-323-6658
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN504960L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYGRP528724001OtherBCBS
PA1534113OtherBLUE SHIELD
PA101382108Medicaid
NYGRP528724001OtherBCBS