Basic Information
| Provider Information | |||||||||
| NPI: | 1720059058 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DARVILLE | ||||||||
| FirstName: | AUDREY | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 450 F COLLEGE OF NURSING | ||||||||
| Address2: | UNIVERSITY OF KENTUCKY | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593234222 | ||||||||
| FaxNumber: | 8593231200 | ||||||||
| Practice Location | |||||||||
| Address1: | 450 F COLLEGE OF NURSING | ||||||||
| Address2: | UNIVERSITY OF KENTUCKY | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593234222 | ||||||||
| FaxNumber: | 8593231200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2006 | ||||||||
| LastUpdateDate: | 04/09/2012 | ||||||||
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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 | 363LF0000X | 3002753 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 000000064838 | 01 | KY | ANTHEM BC/BS | OTHER | 78027539 | 05 | KY | MEDICAID |