Provider Demographics
NPI:1558364026
Name:BEARY, ALICE (CRNA)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:BEARY
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 1:200 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1661
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1644
Practice Address - Country:US
Practice Address - Phone:270-825-5100
Practice Address - Fax:270-326-4968
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3212972367500000X
NC176038367500000X
IL209-003784367500000X
IL041-281137163W00000X
NY513594-1163W00000X
GA152518367500000X
KY3006737367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100229600Medicaid
KY000000801298OtherANTHEM- BAPTIST HEALTH MADISONVILLE INC
KYP01184121OtherRAILROAD MEDICARE
KY7100229600Medicaid