1629055082 NPI number — MRS. GINA MICHELLE HAMILTON APRN

Table of content: MRS. GINA MICHELLE HAMILTON APRN (NPI 1629055082)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629055082 NPI number — MRS. GINA MICHELLE HAMILTON APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMILTON
Provider First Name:
GINA
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAMILTON
Provider Other First Name:
GINA
Provider Other Middle Name:
MICKI
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1629055082
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 BOGLE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOMERSET
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42503-2873
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-678-0705
Provider Business Mailing Address Fax Number:
606-678-2807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 BOGLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42503-2873
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-678-0705
Provider Business Practice Location Address Fax Number:
606-678-2807
Provider Enumeration Date:
12/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LX0001X , with the licence number:  3001453 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20104014 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20109013 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20074019 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20023016 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20027017 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20100012 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20901211 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20116018 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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