Individual
ANDREA MCCOY MEDEARIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3920 DUTCHMANS LN, LOUISVILLE, KY 40207-4702
(502) 259-6710
(502) 259-6704
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-0328
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
1123553
KY
367500000X
Certified Registered Nurse Anesthetist
Primary
3008755
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300045950
—
IN
05
—
7100304640
—
KY
Enumeration date
05/29/2014
Last updated
03/01/2023
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