Healthcare Provider Details

I. General information

NPI: 1336913987
Provider Name (Legal Business Name): MADISON MOBELINI PATRICK MSN, APRN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 LYTTLE BLVD
HAZARD KY
41701-1739
US

IV. Provider business mailing address

325 LYTTLE BLVD
HAZARD KY
41701-1739
US

V. Phone/Fax

Practice location:
  • Phone: 606-438-8665
  • Fax:
Mailing address:
  • Phone: 606-438-8665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4054489
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: