Provider Demographics
NPI:1700888344
Name:GOLDSMITH, KYLE J (CRNA)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:J
Last Name:GOLDSMITH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6801 DIXIE HWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3913
Mailing Address - Country:US
Mailing Address - Phone:502-587-4799
Mailing Address - Fax:502-540-3730
Practice Address - Street 1:225 ABRAHAM FLEXNER WAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1882
Practice Address - Country:US
Practice Address - Phone:502-587-4799
Practice Address - Fax:502-540-3730
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3002889367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200225420AMedicaid
KY74028895Medicaid
KY00546045Medicare Oscar/Certification
KYP00785250Medicare PIN