Provider Demographics
NPI:1467798488
Name:ADAMS, CHAD RODERICK (APRN-NA)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:RODERICK
Last Name:ADAMS
Suffix:
Gender:M
Credentials:APRN-NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2333 ALUMNI PARK PLZ
Mailing Address - Street 2:ANESTHESIA DEPARTMENT
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-4012
Mailing Address - Country:US
Mailing Address - Phone:859-257-7910
Mailing Address - Fax:859-257-7988
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-257-1000
Practice Address - Fax:859-323-1080
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY1108034163W00000X
KY3007852367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100234720Medicaid
IN300037985Medicaid