Provider Demographics
NPI:1023825643
Name:TWITCHELL, AUSTIN (CRNA)
Entity type:Individual
Prefix:MR
First Name:AUSTIN
Middle Name:
Last Name:TWITCHELL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1252 PASSAGE MOUND WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2146
Mailing Address - Country:US
Mailing Address - Phone:435-592-9115
Mailing Address - Fax:
Practice Address - Street 1:3480 YORKSHIRE MEDICAL PARK # 100
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1886
Practice Address - Country:US
Practice Address - Phone:859-904-5046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4032431367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered