Basic Information
| Provider Information | |||||||||
| NPI: | 1841272119 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARNOLD | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | ANITA | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 636493 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452636493 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139815098 | ||||||||
| FaxNumber: | 5139815015 | ||||||||
| Practice Location | |||||||||
| Address1: | 1025 GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | BEATTYVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 413110204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064648806 | ||||||||
| FaxNumber: | 6064649453 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2005 | ||||||||
| LastUpdateDate: | 02/22/2013 | ||||||||
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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 | 163WC1500X | 1018525 | KY | N | Nursing Service Providers | Registered Nurse | Community Health | 363LF0000X | 3000187 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 78010428 | 05 | KY | MEDICAID |