Individual
FRED T. MANSMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1850 BLUEGRASS AVE, LOUISVILLE, KY 40215-1161
(502) 361-6617
(502) 361-6637
Mailing address
6801 DIXIE HWY, SUITE 130, LOUISVILLE, KY 40258-3913
(502) 361-6617
(502) 361-6637
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
3001440
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
430051864
RR MEDICARE
KY
05
—
74174723
—
KY
Enumeration date
05/26/2006
Last updated
01/12/2011
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