Provider Demographics
NPI:1295722403
Name:SEDLOCK, JOANNE RUTH (CRNA)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:RUTH
Last Name:SEDLOCK
Suffix:
Gender:F
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:PO BOX 34748
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40232-4748
Mailing Address - Country:US
Mailing Address - Phone:502-473-2132
Mailing Address - Fax:502-459-0923
Practice Address - Street 1:4000 KRESGE WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4605
Practice Address - Country:US
Practice Address - Phone:502-473-2132
Practice Address - Fax:502-459-0923
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10010157367500000X
KY3003917367500000X
KY1042912163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000283601OtherBLUE SHIELD
KY2818868000OtherPASSPORT ADVANTAGE
KY74006610Medicaid
430079853OtherRAILROAD MEDICARE
KY50013925OtherPASSPORT
KYK035560Medicare UPIN