Basic Information
| Provider Information | |||||||||
| NPI: | 1245542331 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CALHOUN | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | DEREK | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 123 E CRAWFORD ST | ||||||||
| Address2: | |||||||||
| City: | FINDLAY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458404802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5672049459 | ||||||||
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| Practice Location | |||||||||
| Address1: | 440 HOPKINSVILLE ST | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703388392 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2010 | ||||||||
| LastUpdateDate: | 06/05/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 3006511 | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2100X | 3006511 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | 7100135560 | 05 | KY | MEDICAID |