Basic Information
Provider Information | |||||||||
NPI: | 1497026132 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GREENWELL PERKINS | ||||||||
FirstName: | KATHRYN | ||||||||
MiddleName: | DRU | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | APRN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | GREENWELL | ||||||||
OtherFirstName: | KATHRYN | ||||||||
OtherMiddleName: | DRU | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1510 | ||||||||
Address2: |   | ||||||||
City: | EVANSVILLE | ||||||||
State: | IN | ||||||||
PostalCode: | 477061510 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2708274596 | ||||||||
FaxNumber: | 2708262838 | ||||||||
Practice Location | |||||||||
Address1: | 1300 MERRITT DR STE 100 | ||||||||
Address2: |   | ||||||||
City: | HENDERSON | ||||||||
State: | KY | ||||||||
PostalCode: | 424202788 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2708270064 | ||||||||
FaxNumber: | 2708263338 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/25/2012 | ||||||||
LastUpdateDate: | 10/07/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 3007067 | KY | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.