Individual
CARLY COOPER WHITAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
150 N EAGLE CREEK DR, LEXINGTON, KY 40509-1805
(859) 268-1030
(859) 269-4120
Mailing address
425 LEWIS HARGETT CIR, LEXINGTON, KY 40503-3590
(859) 268-1030
(859) 269-4120
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
085916
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000702826
ANTHEM
—
05
—
201012540
—
IN
05
—
3128832
—
OH
01
—
611077369 129571685
HEALTHNET
—
05
—
7100151350
—
KY
Enumeration date
01/26/2011
Last updated
03/27/2018
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