1346673647 NPI number — KATOSHA NICOLE RUSSELL MSN, APRN, FNP-BC.

Table of content: KATOSHA NICOLE RUSSELL MSN, APRN, FNP-BC. (NPI 1346673647)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346673647 NPI number — KATOSHA NICOLE RUSSELL MSN, APRN, FNP-BC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUSSELL
Provider First Name:
KATOSHA
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, APRN, FNP-BC.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THORNSBERRY-RUSSELL
Provider Other First Name:
KATOSHA
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN, APRN, FNP-BC.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346673647
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 909
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40201-0909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-789-1112
Provider Business Mailing Address Fax Number:
270-789-3157

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
73 KINGSWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMPBELLSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42718-9604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-789-1112
Provider Business Practice Location Address Fax Number:
270-789-3157
Provider Enumeration Date:
08/10/2013

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: 363LF0000X , with the licence number:  3008196 , 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)





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