Provider Demographics
NPI:1790732246
Name:CARY, JAMIE B (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:B
Last Name:CARY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:504 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42345-1134
Mailing Address - Country:US
Mailing Address - Phone:270-684-5005
Mailing Address - Fax:270-926-4432
Practice Address - Street 1:815 E PARRISH AVE
Practice Address - Street 2:SUITE 460
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3222
Practice Address - Country:US
Practice Address - Phone:270-684-5005
Practice Address - Fax:270-926-4432
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4154A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74007212Medicaid
KY0980723Medicare ID - Type Unspecified