Healthcare Provider Details

I. General information

NPI: 1659789899
Provider Name (Legal Business Name): RUTH H. NELSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 MAIN STREET
CRAB ORCHARD KY
40419
US

IV. Provider business mailing address

PO BOX 84
CRAB ORCHARD KY
40419
US

V. Phone/Fax

Practice location:
  • Phone: 606-355-7800
  • Fax: 606-355-7803
Mailing address:
  • Phone: 606-355-7800
  • Fax: 606-355-7803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3008779
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: