Individual
MR. JONATHAN D LAVERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1025 NEW MOODY LN, LAGRANGE, KY 40031-9154
(502) 222-3886
(502) 222-8647
Mailing address
1011 HARDIN HOLLY, LAGRANGE, KY 40031-8985
(502) 222-1170
(502) 222-8647
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1089893
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000188229
ABCBS PROVIDER #
KY
01
—
000000375186
GLAS/DT KY PRVD #
KY
05
—
1138502
—
KY
05
—
74028028
—
KY
Enumeration date
10/03/2006
Last updated
07/09/2007
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