Basic Information
Provider Information | |||||||||
NPI: | 1932489325 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FURMAN | ||||||||
FirstName: | TORRIE | ||||||||
MiddleName: | L | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | APRN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BOOMERSHINE | ||||||||
OtherFirstName: | TORRIE | ||||||||
OtherMiddleName: | L | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | APRN | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 784 HIGHWAY 36 | ||||||||
Address2: |   | ||||||||
City: | FRENCHBURG | ||||||||
State: | KY | ||||||||
PostalCode: | 403228123 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6067689190 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 17 MILLER DR | ||||||||
Address2: |   | ||||||||
City: | OWINGSVILLE | ||||||||
State: | KY | ||||||||
PostalCode: | 403602212 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6066743033 | ||||||||
FaxNumber: | 6066743036 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/17/2011 | ||||||||
LastUpdateDate: | 12/22/2016 | ||||||||
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 | 363LF0000X | 3007117 | KY | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
ID | Type | State | Issuer | Description | 7100196030 | 05 | KY |   | MEDICAID |