Provider Demographics
NPI:1811055379
Name:MOSER, JOY CHRYSANNE (CRNA)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:CHRYSANNE
Last Name:MOSER
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 1:6801 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:502-261-2180
Mailing Address - Fax:502-240-6481
Practice Address - Street 1:200 ABRAHAM FLEXNER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1818
Practice Address - Country:US
Practice Address - Phone:502-584-0166
Practice Address - Fax:502-584-0144
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2869A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0399811OtherANTHEM SENIOR
KY200197630AMedicaid
KY000000190338OtherANTHEM
KY1108194OtherPASSPORT
KY00546210Medicare Oscar/Certification
KY19801Medicare ID - Type UnspecifiedMEDICARE
KY000000190338Medicare ID - Type UnspecifiedPASSPORT ADVANTAGE