Provider Demographics
NPI:1700320389
Name:HAMBLETON, CODY LIND (APRN-NA)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:LIND
Last Name:HAMBLETON
Suffix:
Gender:M
Credentials:APRN-NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:SUITE 800 - BUSINESS OFFICE
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:502-587-4404
Mailing Address - Fax:502-587-4156
Practice Address - Street 1:200 ABRAHAM FLEXNER WAY
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2877
Practice Address - Country:US
Practice Address - Phone:502-587-4404
Practice Address - Fax:502-587-4156
Is Sole Proprietor?:No
Enumeration Date:2016-12-15
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1147682163W00000X
KY3011053367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100442980 (KOHMG)Medicaid
KYP01790400-KOHMGOtherRR MEDICARE
KYK206980-KOHMGOtherMEDICARE
IN300001114-KOHMGMedicaid