Healthcare Provider Details

I. General information

NPI: 1790704146
Provider Name (Legal Business Name): PAULA WENTWORTH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAULA STEWART APRN

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7388 TURFWAY RD
FLORENCE KY
41042-1381
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-212-7000
  • Fax: 859-212-7010
Mailing address:
  • Phone: 859-212-7000
  • Fax: 859-212-7010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3003896
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3003896
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: