Healthcare Provider Details

I. General information

NPI: 1407197635
Provider Name (Legal Business Name): JOANNA L BLOOMER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2013
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 SAINT CHRISTOPHER DR STE 321
ASHLAND KY
41101-7087
US

IV. Provider business mailing address

3701 LANDSDOWNE DR
ASHLAND KY
41102-5422
US

V. Phone/Fax

Practice location:
  • Phone: 606-329-8588
  • Fax:
Mailing address:
  • Phone: 606-324-3005
  • Fax: 606-329-1530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3007981
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number3007981
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3007891
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: