Healthcare Provider Details

I. General information

NPI: 1164761748
Provider Name (Legal Business Name): DENISE EVANS ADAMS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2013
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 W FAIRVIEW AVE
EDDYVILLE KY
42038-8259
US

IV. Provider business mailing address

PO BOX 595
EDDYVILLE KY
42038-0595
US

V. Phone/Fax

Practice location:
  • Phone: 270-388-5454
  • Fax: 270-388-5452
Mailing address:
  • Phone: 270-388-5454
  • Fax: 270-388-5452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3007909
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: