Individual
MARY MARTHA DOWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
4305 NEW SHEPHERDSVILLE RD, BARDSTOWN, KY 40004-9019
(502) 350-5032
(502) 350-5022
Mailing address
PO BOX 936, LONDON, KY 40743-0936
(502) 350-5032
(502) 350-5022
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
042295
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000491683
BCBS PROVIDER NUMBER
KY
01
—
000000558039
ANTHEM
—
05
—
200896870
—
IN
05
—
2585920
—
OH
01
—
50053844
PASSPORT-SME
KY
05
—
74016627
—
KY
Enumeration date
05/02/2006
Last updated
08/12/2019
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