Provider Demographics
NPI:1851467526
Name:CRADY, BEVERLY JO (CST CFA)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:JO
Last Name:CRADY
Suffix:
Gender:F
Credentials:CST CFA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1520 SANDERS LANE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216
Mailing Address - Country:US
Mailing Address - Phone:502-366-5965
Mailing Address - Fax:502-361-6637
Practice Address - Street 1:1520 SANDERS LANE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216
Practice Address - Country:US
Practice Address - Phone:502-366-5965
Practice Address - Fax:502-361-6637
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY92630363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant