Provider Demographics
NPI:1346208246
Name:DOWELL, MARY MARTHA (CRNA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:MARTHA
Last Name:DOWELL
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:502-350-5032
Mailing Address - Fax:502-350-5022
Practice Address - Street 1:4305 NEW SHEPHERDSVILLE RD
Practice Address - Street 2:
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:2006-05-02
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY042295367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000558039OtherANTHEM
OH2585920Medicaid
KY50053844OtherPASSPORT-SME
KY000000491683OtherBCBS PROVIDER NUMBER
KY74016627Medicaid
IN200896870Medicaid
000000558039OtherANTHEM
IN200896870Medicaid
KYP01249285 RRMedicare PIN
0918148Medicare PIN
KY50053844OtherPASSPORT-SME
000000558039OtherANTHEM
KY0664014Medicare ID - Type Unspecified
KY74016627Medicaid
KYP00403841Medicare PIN