Healthcare Provider Details

I. General information

NPI: 1295196137
Provider Name (Legal Business Name): MIRANDA TOMPKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 MIDDLE SCHOOL RD
ALBANY KY
42602-7931
US

IV. Provider business mailing address

PO BOX 1080
BURKESVILLE KY
42717-1080
US

V. Phone/Fax

Practice location:
  • Phone: 844-435-0900
  • Fax: 606-858-4607
Mailing address:
  • Phone: 270-864-1472
  • Fax: 270-858-4607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3010187
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: