Individual
JO ELAINE BEATY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1400 POPLAR LEVEL RD STE 100, LOUISVILLE, KY 40217-1309
(502) 637-4800
(502) 637-1550
Mailing address
6306 SHADOW WOOD DR, PROSPECT, KY 40059-9626
(502) 228-8576
(502) 637-1550
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1039608
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1105370
PASSPORT
KY
01
—
24364444000
PASSPORT ADVANTAGE
KY
01
—
2441053
AETNA
—
05
—
74001405
—
KY
Enumeration date
08/13/2006
Last updated
07/09/2007
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