Healthcare Provider Details

I. General information

NPI: 1215991567
Provider Name (Legal Business Name): LINDA G GENTRY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 SAINT CLAIR ST STE 205
FRANKFORT KY
40601-1845
US

IV. Provider business mailing address

PO BOX 996
GEORGETOWN KY
40324-0996
US

V. Phone/Fax

Practice location:
  • Phone: 859-813-4149
  • Fax: 859-545-4979
Mailing address:
  • Phone: 859-813-4149
  • Fax: 859-545-4979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number1076608
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3004767
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: