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NPI Code Detail

MEDICARE: J COLLEEN RUSSELL CPNP, APRN

MEDICARE: J COLLEEN RUSSELL CPNP, APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1364SP0200XPediatric Clinical Nurse Specialist3040PKY
2363LP0200XPediatric Nurse Practitioner3003040KY

General Provider Information

NPI Number : 1528268224
Entity Type Code : Individual
Provider Name (Legal Business Name) : J COLLEEN RUSSELL CPNP, APRN
Provider Business Mailing Address
First Line : 713 W MAIN ST
Second Line :
City : ELKTON
State : KY
Zip : 42220-9229
Country : US
Telephone Number : 270-265-5353
Fax Number : 270-265-5350
Provider Business Practice Location Address
First Line : 713 W MAIN ST
Second Line :
City : ELKTON
State : KY
Zip : 42220-9229
Country : US
Telephone Number : 270-265-5353
Fax Number : 270-265-5350
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2007
Last Update Date : 03/07/2023

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