Provider Demographics
NPI:1508853532
Name:HARRIS, SPRING PAIGE (CRNA)
Entity Type:Individual
Prefix:
First Name:SPRING
Middle Name:PAIGE
Last Name:HARRIS
Suffix:
Gender:F
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:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-0328
Mailing Address - Fax:
Practice Address - Street 1:3920 DUTCHMANS LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4702
Practice Address - Country:US
Practice Address - Phone:502-259-6710
Practice Address - Fax:502-259-6704
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1062992367500000X
KY3002595367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCH6488OtherRAILROAD MEDICARE GROUP
KY2437374000OtherPASSPORT ADVANTAGE
IN201364120Medicaid
KY000000240541OtherBLUE SHIELD
KY1125369OtherPASSPORT
KY74025958Medicaid
KY430047498OtherRAILROAD MEDICARE
KYCH6488OtherRAILROAD MEDICARE GROUP
KY430047498Medicare PIN