Healthcare Provider Details

I. General information

NPI: 1053540674
Provider Name (Legal Business Name): MICHELLE LOUISE BROUGHTON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 KNOX ST
BARBOURVILLE KY
40906-1304
US

IV. Provider business mailing address

PO BOX 1325
CORBIN KY
40702-1325
US

V. Phone/Fax

Practice location:
  • Phone: 606-546-6027
  • Fax: 606-546-2084
Mailing address:
  • Phone: 606-526-8131
  • Fax: 606-528-8661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3006067
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: