Provider Demographics
NPI:1487650115
Name:AYO, ERNEST PAUL (CRNA)
Entity Type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:PAUL
Last Name:AYO
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 1:659 SHERWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:GILBERTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42044
Mailing Address - Country:US
Mailing Address - Phone:270-362-9480
Mailing Address - Fax:270-362-9480
Practice Address - Street 1:659 SHERWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:GILBERTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42044
Practice Address - Country:US
Practice Address - Phone:270-362-9480
Practice Address - Fax:270-362-9480
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI470417018367500000X
KY4120A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74008046Medicaid
0982309Medicare UPIN