Provider Demographics
NPI:1972687424
Name:COLE, JON P (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:P
Last Name:COLE
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 1:1800 NICHOLASVILLE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1433
Mailing Address - Country:US
Mailing Address - Phone:859-276-1557
Mailing Address - Fax:859-276-3188
Practice Address - Street 1:1800 NICHOLASVILLE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1433
Practice Address - Country:US
Practice Address - Phone:859-276-1557
Practice Address - Fax:859-276-3188
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4021A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY55131OtherCRNA CERTIFICATION
KY74007154Medicaid
KY74007154Medicaid