Provider Demographics
NPI:1841521481
Name:ELLISON, DAVID S (CRNA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:ELLISON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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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:502-315-1458
Mailing Address - Fax:502-479-1425
Practice Address - Street 1:4305 NEW SHEPHERDSVILLE RD
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-9019
Practice Address - Country:US
Practice Address - Phone:502-350-5032
Practice Address - Fax:502-350-5022
Is Sole Proprietor?:No
Enumeration Date:2010-01-21
Last Update Date:2013-05-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN14616367500000X
KY3007236367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100100860Medicaid
KY7100100860Medicaid
KYK059402Medicare PIN