Individual
JESSICA D SHADBURNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3920 DUTCHMANS LN, LOUISVILLE, KY 40207-4702
(502) 259-6710
(502) 259-6704
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-0328
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
1094943
KY
367500000X
Certified Registered Nurse Anesthetist
Primary
3003303
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000245148
BLUE SHIELD
KY
01
—
1134761
PASSPORT
KY
05
—
201208770
—
IN
01
—
2437849000
PASSPORT ADVANTAGE
KY
01
—
430063052
RAILROAD MEDICARE
KY
05
—
74441502
—
KY
01
—
CH6488
RR MEDICARE GROUP NUMBER
KY
Enumeration date
10/04/2005
Last updated
03/01/2023
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