Provider Demographics
NPI:1477729218
Name:AITKEN, STEPHEN (CRNA)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:AITKEN
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 1:153 DOWELL RD
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642-4579
Mailing Address - Country:US
Mailing Address - Phone:270-866-4141
Mailing Address - Fax:270-866-7148
Practice Address - Street 1:153 DOWELL RD
Practice Address - Street 2:
Practice Address - City:RUSSELL SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42642-4579
Practice Address - Country:US
Practice Address - Phone:270-866-4141
Practice Address - Fax:270-866-7148
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3001919367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74001512Medicaid
KY3355156Medicare PIN