Healthcare Provider Details

I. General information

NPI: 1063885408
Provider Name (Legal Business Name): DEBORAH TRUESDELL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2015
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 COURTHOUSE XING
INDEPENDENCE KY
41051-2509
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-356-6800
  • Fax: 859-363-4073
Mailing address:
  • Phone: 859-356-6800
  • Fax: 859-363-4073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3009866
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3009866
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: