Provider Demographics
NPI:1730133497
Name:RUDD, BART A (MSN-CRNA)
Entity Type:Individual
Prefix:MR
First Name:BART
Middle Name:A
Last Name:RUDD
Suffix:
Gender:M
Credentials:MSN-CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:606-330-6000
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:1001 SAINT JOSEPH LN
Practice Address - Street 2:ANESTHESIA PROGRAM
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-8345
Practice Address - Country:US
Practice Address - Phone:606-330-6000
Practice Address - Fax:606-330-7825
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYRN1080380/ARNP3119A367500000X
KY1080380367500000X
KY3119A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74002726Medicaid
KY1223572OtherCHA HEALTH
KY000000375720OtherANTHEM BCBS KY
KY000000375720OtherBLUE CROSS/BLUE SHIELD
KYP00255461OtherRAILROAD MEDICARE PIN
KY0907307Medicare PIN
KY000000375720OtherANTHEM BCBS KY