Healthcare Provider Details

I. General information

NPI: 1861880221
Provider Name (Legal Business Name): ELIZABETH SKINNER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 CEDAR ST
KUTTAWA KY
42055-6287
US

IV. Provider business mailing address

91 CEDAR ST
KUTTAWA KY
42055-6287
US

V. Phone/Fax

Practice location:
  • Phone: 270-388-7380
  • Fax:
Mailing address:
  • Phone: 270-388-7380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3009151
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: