Basic Information
| Provider Information | |||||||||
| NPI: | 1316948250 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUBLETT | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 811 E PARRISH AVE | ||||||||
| Address2: | |||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423033258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706883371 | ||||||||
| FaxNumber: | 2706883370 | ||||||||
| Practice Location | |||||||||
| Address1: | 811 E PARRISH AVE | ||||||||
| Address2: | |||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423033258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706883371 | ||||||||
| FaxNumber: | 2706883370 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2005 | ||||||||
| LastUpdateDate: | 01/12/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 3003527 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 000000617707 | 01 | KY | COOP HEALTH BCBS # | OTHER | P00473272 | 01 | KY | RR MEDICARE | OTHER | 0992319 | 01 | KY | MEDICARE | OTHER | 78006574 | 05 | KY | MEDICAID | 000000586347 | 01 | KY | BCBS | OTHER |