Basic Information
| Provider Information | |||||||||
| NPI: | 1598060899 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VINCENT | ||||||||
| FirstName: | KATHY | ||||||||
| MiddleName: | LYNNE | ||||||||
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| Credential: | APRN, NP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 37 | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 424500037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706677017 | ||||||||
| FaxNumber: | 2706679065 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 424501261 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706677017 | ||||||||
| FaxNumber: | 2706679065 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2011 | ||||||||
| LastUpdateDate: | 03/02/2018 | ||||||||
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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 | 3006796 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 201020300 | 05 | IN | MEDICAID | 7100155800 | 05 | KY | MEDICAID |