Provider Demographics
NPI:1770565160
Name:JONES, MISTY DESHAY (CRNA)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:DESHAY
Last Name:JONES
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:DEPT 86236
Mailing Address - Street 2:PO BOX 950195
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0001
Mailing Address - Country:US
Mailing Address - Phone:502-473-2100
Mailing Address - Fax:502-459-6461
Practice Address - Street 1:3 AUDUBON PLAZA DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1319
Practice Address - Country:US
Practice Address - Phone:502-636-7449
Practice Address - Fax:502-636-7950
Is Sole Proprietor?:No
Enumeration Date:2005-11-19
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3890A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74006412Medicaid
KY000000271732OtherBCBS
KY430080059Medicare PIN
KY000000271732OtherBCBS
KY0601378Medicare PIN
KY0783037Medicare PIN
KY74006412Medicaid